umbilical hernia repair

Umbilical hernia is divided into 3 types, namely umbilical bulge (infant or embryonic umbilical hernia), pediatric and adult. Umbilical bulge is the least common, the incidence rate is 1 / 5000, is a congenital defect, the intra-abdominal organs protruding into the umbilical cord are covered with only a layer of amnion and peritoneum, no skin covering. If exposed to the air for a long time, it will dry quickly and cause necrosis, so that the viscera bulges from the defect. Pediatric umbilical hernia is more common, the incidence rate is 1%, mostly occurs within 2 years old, often due to congenital umbilical abdominal wall defects and increased intra-abdominal pressure. The outer capsule is covered with skin and peritoneum. Adult umbilical hernia is less common, mostly in middle age. The cause of the disease is due to defects in the umbilicus and on the other hand due to increased intra-abdominal pressure. Treatment of diseases: umbilical hernia umbilical Indication 1. Umbilical bulging should be performed immediately after birth. 2. Pediatric umbilical hernia, such as within 2 years old, the diameter is less than 2cm, can be tested with tape inversion, such as diameter greater than 2cm, or after 2 years of age still not self-healing, should be surgically repaired. 3. Adult umbilical hernia, although the incidence of incarceration is not high, but because it is not easy to self-heal, should be treated surgically. 4. Various incarcerated umbilical hernia should be treated urgently. Preoperative preparation 1. If there is a factor of increased intra-abdominal pressure (such as cough, constipation, etc.), it should be eliminated before surgery. 2. Other preoperative preparations are the same as general inguinal hernia repair. Surgical procedure Take the pediatric umbilical hernia as an example. Make an arc-shaped incision along the lower edge of the umbilicus. The length of the incision can be upturned and the sac is revealed. After the skin is cut, continue to cut the subcutaneous superficial fascia, reveal the anterior sheath of the rectus abdominis, bluntly separate the umbilical hernia sac, make an elliptical incision at the base, and cut the ventral midline fascia and part of the rectus abdominis. Front sheath. Separate the adhesion tissue around the hernia sac and cut the sac. When cutting, care should be taken to avoid damage to the sputum contents. After separating the peritoneum around the ankle ring, lift it with a hemostatic forceps, open it, and then use the little finger to probe into the ankle ring. Check for any important organs and adhesions nearby. After the sac is cleaned, remove the excess sac and the peritoneum. The peritoneum was used for intermittent valgus suture, and the abdominal cavity was closed. The fascial margin of the overlapping midline and the anterior sheath of the rectus abdominis (the upper flap overlaps about 2 to 3 cm above the lower valve), and the lower flap is sutured with a 4-0 or 7-0 silk thread. Below the flap, the upper flap is then placed over the lower flap for intermittent suture, and the needle should not be too deep to avoid damage to the abdominal internal organs. After the fascia is repaired, first use the finger to open the umbilicus of the upper incision of the skin incision, loosen the surrounding adhesion, and then use the gauze with the other hand to press the umbilicus. Then, the subcutaneous tissue of the umbilicus is sutured and fixed on the fascia surface of the midline. It is best to fix the superficial fascia to the deep fascia and the rectus abdominis anterior sheath. Finally, the subcutaneous tissue and skin are sutured intermittently. For larger isolated wounds, cigarette drainage should be placed between the subcutaneous and fascia.