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

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative Complications

    • Intraoperative Bleeding

      Especially of the epigastric vessels or their branches

      Therapy: immediate ligation/hemostasis
       
    • Intestinal Injury

      If an accidental iatrogenic intestinal lesion occurs intraoperatively, oversewing should be performed immediately!

  2. Postoperative Complications

    • Postoperative Bleeding/Hematoma

      Sonographic control, in case of size progression possibly puncture. Hb-relevant postoperative bleedings and large symptomatic hematomas must be revised.
       
    • Seroma

      A seroma is regularly present depending on the size of the hernia sac and without therapeutic consequence, possibly sonographic follow-up control. If the size of the seroma leads to clinical symptoms, a puncture (absolutely sterile!) can be performed in individual cases (possibly with microbiological examination). In case of recurrent seromas, do not puncture multiple times, but then insert a drainage under sonographic control and drain consistently for a few days. Caution: Every puncture increases the risk of mesh infection.
       
    • Unnoticed Secondary Bowel Perforation

      In case of deviation from the expected postoperative course and suspicion of an unrecognized bowel lesion (fever, peritonism, ileus, infection parameters), surgical exploration must be performed. Reoperation with detection of the bowel lesion and oversewing, possibly resection and abdominal lavage, antibiotic treatment, possibly mesh explantation. Lethality approx. 3 %.
       
    • Postoperative Bowel Paralysis/Manifest Ileus

      Attempt with conservative bowel stimulation possibly administration of a prokinetic (e.g. Neostigmine). In case of a manifest ileus reoperation with detection and elimination of the cause.
       
    • Chronic Postoperative PainChronic postoperative pain defined as early as 1986 by the «International Association for the Study of Pain» as pain that persists for more than three months despite optimal conservative therapy. Possible causes are traumatic damage to the nerves by suturing during mesh fixation, especially when using non-resorbable suture material.

      Consistent postoperative analgesia. In case of therapy-refractory pain that is punctually localized to a thread/knot, this should be removed via a circumscribed access. Mesh removal ultima ratio.

      Risk factors are pre-existing or poorly controlled early postoperative pain and female gender.
       
    • Wound Infection/Mesh InfectionSuperficial wound infection: Conservative approach with open wound treatment

      Subfascial wound infection with mesh involvement: open wound treatment, possibly VAC
       
    • Recurrence approx. 10 - 15 %

      Risk factor is intra-abdominal adiposity

      Consider reoperation