- Risk profile of the patient (see also menu item Hernia)
- Size of the hernia and classification of the hernia (European classification since 2009)
- Load profile if the patient
- The patient’s wishes
In the case of small umbilical hernias with a diameter of up to 1.5 cm, and a low risk profile of the patient, a stitching procedure is usually used. Nowadays the sutures are mostly made with a running purse string suture of a non-dissolving material in accordance with DICK or ISRAELSSON. Fasciae duplication procedures no longer play a role today due to the development of too much stress on the seams of the abdominal wall, since a higher rate of relapse is observed (= recurrence of fractures)**.
There are many different possibilities for supply of the mesh with different materials and different mesh sizes. We prefer so-called rear = retro-muscular techniques which stabilize the fracture gap from the inside. A practical comparison from daily life is the rusty pail with a hole which is best sealed by a newspaper from the inside so that the sand does not pour out. There are, for example, special coated meshes are the used in the abdominal cavity as so-called IPOM (intraperitoneal onlay mesh plastic) . Otherwise, there are meshes which are used between the peritoneum and the innermost abdominal muscle layer as a so-called **sublay mesh. The size of the mesh depends on the fracture gap diameter and texture of the surrounding area. An overlap of the fracture gap of 2-5 cm is a prerequisite for a good long-term result. In general we attach the mesh with non-dissolvable seams and not with a so-called stapler. In principle, the concept of lightness and macroporosity of the mesh materials, which allows sufficient stability but very good flexibility, also applies.
What happens after surgery?
The recommendations for an inguinal hernia also apply to umbilical hernias (see menu item Inguinal Hernia)!