Open umbilical prosthesis
Open umbilical prosthesis
Operation
For an umbilical hernia, an incision is made usually in the contour following the skin crease of the lower part of the umbilicus. In an epigastric hernia, an incision is made above the bulge of the hernia on the midline. In case of an umbilical hernia the belly button is first detached from the hernia or the abdominal wall. The hernia contents are isolated. If the hernia contains intestine, it is pushed back into the abdomen. If the hernia contains abdominal fat, it is removed.
A prosthesis with a diameter from 4 to 9 cm, depending on the defect in the abdominal wall, is inserted through the hernia opening into the abdomen. It can be placed in the abdomen behind the abdominal muscle wall or behind the abdominal wall in front of the peritoneum (membrane which surrounds all the organs in the abdomen). The hole above the prosthesis is then closed with sutures. When treating an umbilical hernia, the belly button is fixed to the abdominal wall with a thread.
What is a biphasic prosthesis/mesh?
A biphasic mesh has 2 sides. An upper side of polypropylene silk. Scar tissue will form through and around the openings in the mesh/prosthesis, causing it to be incorporated into the adjacent tissue. This forms a mechanical barrier against pressure and prevents hernia recurrences.
A smooth side on the bowel side that reduces the risk of the prosthesis adhering and growing into the bowel.
If the prosthesis infects and does not respond to antibiotic treatment, it may be necessary to remove the prosthesis / mesh.
A prosthesis is made of polypropylene with the following characteristics :
How long does the procedure take?
Depending on the size of the defect, the procedure takes 30 to 60 minutes.
The operation time is shorter if no prosthesis /mesh is needed.
What should one do to prevent a hernia recurrence after surgery?
For the first 6 weeks after surgery, do not play sports or engage in strenuous physical activities.
Avoid being overweight, as this increases intra-abdominal pressure and therefore the risk of a hernia recurrence.
Incidence : < 4,3 %
Risk factors for recurrence:
Incidence : < 1%
Incidence : 9,2 %
Incidence : 6,5 %
If a large hernia is removed or if part of the hernia sac remains in, the void left after treatment of the hernia may be filled with abdominal fluid (seroma) and blood.
The fluid collection can be emptied by punctures during the consultation, rarely the fluid has to be removed surgically.
Chronic pain after 2 years : +/- 5%
94% have no pain symptoms after 2 years.
< 1,5% when adhesions between bowels and the sac are loosened.
Rare, mostly due to bleeding from small vessels on the abdominal wall. In most cases, bleeding stops spontaneously.
To reduce the risk of complications, it is advisable to :
In normal conditions, pain is well controlled with paracetamol (Dafalgan®), NSAIDs (anti-inflammatories) or morphine (Tradonal®…) and pain symptoms diminish over time.
If certain symptoms seem abnormal to you contact your doctor
If this is not possible, you can contact avec your surgeon.
If you are unable to contact your GP or your surgeon, go to the uremergency department at St Elizabeth Hospital in Uccle.
Pregnancy is always possible after open umbilicus/epigastric hernia repair with mesh or prosthesis.