Paraumbilical

• Umbilical hernias are the most common ventral hernia
• An abnormal protrusion of intra-abdominal contents through a fascial defect in or around the umbilical ring
• • A true (direct) umbilical hernia is a congenital problem which occurs when the umbilical ring fails to close, resulting in herniation of intra-abdominal contents into the middle of the cicatrix - extremely common in children
  • A paraumbilical (indirect) hernia is associated with an acquired fascial defect in the linea alba located within 3cm of the umbilical ring and results in a hernia which lies separate from the cicatrix
• Point of weakness = linea alba around the umbilical region
• Aetiology and risk factors:

  • More common in women, especially during or after pregnancy
  • More likely to cause problems and require surgery in men
  • Chronically raised intra-abdominal pressure due to ascites and obesity - up to 20% of patients with cirrhosis will develop a hernia
• Clinical features:

  • Usually asymptomatic
  • Due to central position in abdomen, symptomatic hernias may contain fat, omentum, small bowel and transverse colon
  • Hernias containing bowel are at risk of obstruction and strangulation
  • Palpable swelling in or around the umbilicus
  • Umbilicus itself may be everted or distorted
  • Overlying skin can become stretched and break down, posing a risk of infection
• Management:

  • Asymptomatic hernias have a low risk of complications - conservative management
  • Majority of symptomatic umbilical hernias should undergo open repair with a mesh
  • Very small hernias or women who plan to become pregnant in the future can be treated with a simple suture repair