Tre­at­ment of um­bi­li­cal and up­per ab­do­mi­nal her­ni­as

The treatment of umbilical and upper abdominal hernias consists of surgical treatment. Several surgical procedures are available. Small hernias with a diameter of less than one centimetre can be closed using simple sutures. Medium-sized and larger hernias usually require the implantation of a non-dissolvable plastic mesh in the abdominal wall. The mesh can be inserted openly via a small incision or minimally invasively. The choice of procedure is determined by the morphology of the hernia and the patient's individual risk factors.

In slender patients in particular, the mesh can be inserted via a small incision in the umbilical skin and the hernia closed with a cosmetically pleasing result. In the case of larger hernias and patients with increased body weight, a correspondingly larger incision would be required to access the abdominal wall. In these cases, a minimally invasive procedure with three 5-12 mm incisions on the side is available as an alternative. Plastic meshes are also used in minimally invasive procedures.

• Open suture closure: This procedure is usually used for small fractures up to a diameter of approx. 1 cm: A small incision is made at the site of the fracture. The tissue in the fracture is then moved back to its original position. The hernia gap is then closed with a suture.
• Open treatment with mesh insertion: For hernias larger than 1 cm, it is usually necessary to insert a plastic mesh to reinforce the abdominal wall. If the mesh is inserted openly, a small incision is made over the hernia. The tissue in the hernia is returned to its correct position and the peritoneum on the inside of the abdominal wall is then detached from it. The mesh is then placed in this newly created space between the peritoneum and the abdominal wall and fixed in place with sutures. The hernia gap is then closed with sutures.
• Endoscopic treatment using the IPOM technique: In endoscopic treatment, three small incisions are made on the side of the abdomen and these are used to enter the abdominal cavity. From here, the hernia gap is freed from the tissue inside and then closed using sutures if possible. A plastic mesh is then placed against the abdominal wall from the inside to reinforce the abdominal wall at the site of the hernia.
• Endoscopic treatment using the total extraperitoneal technique (eTEP): This rather new technique avoids entering the abdominal cavity. The operation is performed in the layers of the abdominal muscles behind the straight abdominal muscles and in front of their posterior connective tissue layer. The contents of the hernia are returned to their correct position, the hernia gap is closed with sutures and the abdominal wall is then reinforced with a synthetic mesh.