Umbilical hernia repair, open, preperitoneal umbilical mesh plasty ("PUMP”-Repair) - general and visceral surgery

Semicircular skin incision along the right lateral margin of the umbilicus.

With delicate dissecting scissors free the hernia sac all around from its adhesions with the subcutaneous tissue without opening it.

360° epifascial dissection with exposure of the fascial margins, followed by freeing the hernia sac from these margins.

Carefully free the peritoneum digitally from the posterior lamina of the fascia; this will open the preperitoneal space 360° around the fascial defect over a length of 3–5cm.

Trim the mesh (Tutomesh® in the video example) to a size of 6×6cm and then arm the corners of the mesh outside the surgical field with the anchor sutures (absorbable, 2/0).

Spread out the planar mesh in the preperitoneal space. Stitch the anchor sutures through the fascia and anchor them lightly with delicate absorbable epifascial clips.

Tip:
Instead of using absorbable clip the mesh may also be anchored by stitching both tails of the sutures through the fascia and tying them anterior to the latter. Tying the knots loosely will help prevent postoperative pain. The technique presented in the video is the safer option.

With nonabsorbable interrupted sutures close the fascial defect transversely and without overlap.

Resuture (absorbable, 2/0 or 3/0) the base of the umbilicus to the fascia. After interrupted subcutaneous sutures close the skin with a running subcuticular suture and SteriStrips.