Perioperative management - Umbilical hernia repair, open, preperitoneal umbilical mesh plasty ("PUMP”-Repair) - general and visceral surgery
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Indications
With an incarceration rate of 30% and a mortality of up to 15%, there is no doubt about the indication for surgical repair of umbilical hernias. One exception are small umbilical hernias with a fascial defect of ≤ 0.5 cm and thus a low risk of incarceration.
Small hernias / up to 2 cm
- Open repair
- No mesh required
- Gold standard: Spitzy repair
Moderate hernias / 2–4cm
- Open repair
- Mesh recommended
- Intraperitoneal mesh repair with anchor sutures
- PUMP technique
Large hernias / > 4 cm
- Open or laparoscopic repair
- Mandatory mesh!
- In large defects PUMP repair is not always indicated.
- IPOM
- Sublay technique
This presentation describes the
open preperitoneal umbilical mesh plasty = PUMP-Repair.
Contraindications
Caution is advised in:
- Cirrhosis of the liver with ascites
- Advanced malignancy
- Cardiopulmonary risk, e.g., heart failure (NYHA III and NYHA IV)
Preoperative diagnostic work-up
Medical history
- Duration and progression of hernia
- If rapidly increasing in size, rule out underlying intraabdominal disease!
Clinical examination
- Palpation with patient standing and supine, possibly Valsalva maneuver
Ultrasound of the abdominal wall
- Entire midline from xyphoid to the pubic symphysis
- Structure of the linea alba: Additional fascial defects, diastasis recti abdominis
Special preparation
- Depilation of the surgical field
- Marking the location of the hernia
- Patient fasting > 6 hours, no liquids > 3 hours
Informed consent
- Secondary healing
- Recurrence
- Hematomas, secondary bleeding
- Bowel injury
- Injury to adjacent structures
- Postoperative ileus
- Infection
- Thrombosis
- Embolism
- Reoperation
- Temporarily impaired postoperative exercise tolerance
- Chronic pain syndrome
- Umbilical skin necrosis
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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