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

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Skin incision
Dissecting the hernia sac
Exposing the fascial margins 360°
Dissecting the preperitoneal space
Preparing the mesh
Positioning the mesh
Closing the fascial defect
Fixating the umbilicus and closing the wound

Authors

Skin incision

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Semicircular skin incision along the right lateral margin of the umbilicus.
Dissecting the hernia sac

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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°

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

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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.