Complications - Umbilical hernia, direct suture

• Intraoperative Bleeding
  
  Especially of the epigastric vessels or their branches
  Therapy: immediate ligation/hemostasis
   
• Bowel Injury
  
  If an accidental iatrogenic bowel lesion occurs intraoperatively, immediate suturing should be performed!

• Bleeding/Hematoma
  
  Ultrasound monitoring, puncture if size progresses. Hemoglobin-relevant bleeding and large symptomatic hematomas must be revised.
   
• Unnoticed Secondary Bowel Perforation
  
  In case of deviation from the expected postoperative course and suspicion of an unrecognized bowel lesion (fever, peritonitis, ileus, infection parameters), surgical exploration is required. Reoperation with detection of the bowel lesion and suturing, possibly resection and abdominal lavage, antibiotic treatment. Mortality approximately 3%.
   
• Postoperative Bowel Paralysis/Manifest Ileus
  
  Attempt conservative bowel stimulation, possibly administer a prokinetic (e.g., Neostigmine). In the case of a manifest ileus, reoperation with detection and resolution of the cause.
   
• Chronic Postoperative Pain

Chronic postoperative pain was defined in 1986 by the "International Association for the Study of Pain" as pain persisting for more than three months despite optimal conservative therapy.

Consistent postoperative analgesia. Risk factors include pre-existing or poorly controlled early postoperative pain and female gender.
 

• Wound Infection
  
  Conservative approach with open wound treatment
   
• Recurrence approximately 10 - 15%
  
  Risk factor is intra-abdominal obesity
  
  Consider reoperation with mesh placement