Umbilical Hernia

A hernia is a defect in the muscles and connective tissue of the abdomen. Sometimes the fat or intestine can push through this defect and cause pain and a noticeable lump. An umbilical hernia is a defect of the abdominal wall near the navel.

This is caused by muscles that do not close around the opening left by the umbilical cord and are usually present at birth.

Adults usually notice a bulge in the belly button that is caused by increases in abdominal pressure. Chronic cough, obesity, fluid accumulation in the belly due to liver disease (cirrhosis) and frequent pregnancies can cause umbilical hernias.

Most people who have umbilical hernias do not have problems related to the hernia other than the visible lump if present.

What to do if you have an umbilical hernia?

If you notice a hernia (or lump), it is best to consult with your doctor to determine the appropriate course of action. In children, umbilical hernias usually close as the child grows. If the hernia is seen in children older than 5 years, then it is often repaired surgically.

In the case of adults, very small umbilical hernias that cause no symptoms are often seen, but adult umbilical hernias that become painful or enlarge in size are usually surgically repaired.

The surgery can be a minimally invasive repair or an open repair.

TEP Technique

The classical TEP technique is the laparoscopic technique considered closest to ideal for inguinal hernia repair, but the technique has several drawbacks such as limited space for dissection and mesh placement, restricted port placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique.

These disadvantages may explain the low implementation of the technique outside the circle of experts. We describe an extended-view modification, the eTEP technique, which overcomes several of these drawbacks.

The eTEP technique is based on the premise that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall.

The eTEP approach can quickly and easily create an extraperitoneal space, enlarge the surgical field, provide a flexible port setup adaptable to many situations, allow unencumbered parietalization of the cord structures (proximal dissection of the sac and peritoneum), ease the management of the distal sac in cases of large inguinoscrotal hernias, and improve tolerance of pneumoperitoneum, which is a common complication.

We believe that the eTEP technique has a place in the armamentarium of the hernia surgeon. Residents and surgeons in training will find this technique easier to master.

The eTEP can expand the traditional indications of the extraperitoneal approach to patients with difficult body habitus, a short umbilicus-pubis distance, and previous pelvic surgery, and as experience is gained, the indications for traditional TEP can expand to more complex cases.

Mesh to repair the hernia

The mesh is a material that provides additional support to the weakened abdominal wall during the repair of the hernia. Can be of plastic or animal tissue.

For adults, the use of mesh is usually based on the size of the defect; the smallest mistakes can be repaired by merely closing the weakness in the muscles, and the more significant defects are fixed with a plastic mesh. The placement of the mesh decreases the possibility that the umbilical hernias will occur again.