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Umbilical, epigastric hernias. Diagnosis, when to consult, when and how to operate?

Updated: Nov 15, 2022



The umbilical hernia and the epigastric hernia are a hole in the abdominal wall, we can put in the same category the small incisional hernias on a scar from open or endoscopic surgery.


The umbilical hernia and the epigastric hernia are a hole in the abdominal wall, we can put in the same category the small incisional hernias on a scar from open or endoscopic surgery. The diagnosis can be made by the simple presence of a bulge or swelling in the belly button area. which can increase in volume during an effort, such as coughing for example.




The hernia can be responsible for discomfort, even pain. The main complication is hernial strangulation with the incarceration of an intestinal loop, the hernia is then very painful, vomiting is frequent, surgery must be carried out urgently. In other situations it is the thinning of the skin, and the appearance of cutaneous trophic disorders which can draw intention. The presence of a ventral hernia should lead to a surgical consultation in search of a possible surgical indication. An ultrasound is sometimes useful, it must be requested by the specialist. The clinical examination performed by the surgeon is usually sufficient for the diagnosis. The existence of pain, a bulge or swelling of the umbilicus, the presence of intestine in the hernia are usually indications for surgery.



For a small asymptomatic hernia, simple monitoring is sufficient.


How to operate a ventral hernia and why widely use a prosthesis ?


The use of a prosthesis is practically systematic for the treatment of ventral hernias, except for the smallest hernias whose size does not exceed a few millimeters, then a simple suture can be proposed.




The prosthetic material can be inserted either openly (small aesthetic incision next to the hernia) or endoscopically. The use of endoscopic surgery should only be limited to rare cases. This technique can lead to specific, rare, but sometimes serious intraoperative complications (intestinal wounds, vascular, etc.). The placement of prosthetic material in the intraperitoneal position can also create postoperative adhesions and lead to late complications (intestinal obstruction), migration of prosthetic material, etc.). In the vast majority of cases, the prosthesis is therefore applied in an extraperitoneal position, through a small aesthetic incision under « light » general anesthesia, during a hospital stay of a few hours. The patient can take a shower the day after the operation, without any specific postoperative care.




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