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

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date of publication: 29.04.2013

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  • Skin incision

    Video
    143-7-neu

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

  • Dissecting the hernia sac

    Video
    143-8-neu

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

  • Exposing the fascial margins 360°

    Paid content (video)
    Paid content (image)

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

  • Dissecting the preperitoneal space

    Paid content (video)
    Paid content (image)

    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.

  • Preparing the mesh

    Paid content (video)
    Paid content (image)

    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).

  • Positioning the mesh

    Paid content (video)
    Paid content (image)

    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.

  • Closing the fascial defect

    Paid content (video)
    Paid content (image)

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

  • Fixating the umbilicus and closing the wound

    Paid content (video)
    Paid content (image)

    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.