Perioperative management - Umbilical hernia, primary suture repair

According to the guidelines of the European Hernia Society and the Americas Hernia Society, umbilical hernia repair by direct suture is possible up to a hernia diameter of < 1 cm, unless there is obesity (BMI > 30) and/or rectus diastasis. 
If a direct suture is considered, Spitzy's operation can be performed, which is presented in this article:

• Incarceration (absolute indication!)
• any symptomatic hernia
• prevention of later incarcerations
• cosmetic

relative in:

• Cirrhosis of the liver with ascites
• Advanced malignancy
• Cardiopulmonary risk, e.g., heart failure (NYHA III and NYHA IV)

• Digital palpation!!
• Inspection: Protrusion, outpouching, pain on exertion
• In obese patients always ultrasound
• CT study only in special cases

• Depilation of the surgical field
• Marking the location of the hernia
• Patient fasting > 6 hours, no liquids > 3 hours
• Possibly pausing anticoagulants

• Secondary bleeding/hematoma
• Intestinal perforation
• Injury of adjacent structures
• Postoperative ileus
• Infection
• Thrombosis
• Embolism
• Recurrence (1-3%)
• Reoperation
• Impaired healing (5-10 %)
• Temporarily impaired postoperative exercise tolerance
• Chronic pain syndrome