Skip to main content
SpringerLink
Log in

Current concepts on adult umbilical hernia

  • Review Article
  • Published:
Hernia Aims and scope Submit manuscript

Summary

Umbilical hernia has not received as much attention as other abdominal wall defects. Prevalence in the adult population is 2% and is much more common in cirrhotic patients and obese middle-aged multiparous women. Adult umbilical hernias have an acquired origin as a consequence of increases in pressure (pregnancy, ascites, etc.), the pull of the abdominal muscles, and the deterioration of connective tissue. Attention needs to be paid to the development of umbilical hernias after laparoscopic trocar insertion. All trocar sites larger than 10 mm should be properly closed after operation. The high morbidity and mortality associated with incarcerated umbilical hernias demand an elective repair in all circumstances. There is a lack of control trials evaluating the results of surgical repairs based on the tight overlapping closure of the umbilical ring described by Mayo, while recurrence after umbilical herniorrhaphy is thought to be a common event. The possibility of the application of biomaterials to the surgical correction of umbilical hernias that have been successfully used in the inguinal canal opens a new field for further clinical investigation. Control studies with long follow-up are now required in order to establish evidence based umbilical surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abrahamson J (1990) Hernias. In: Schwartz SI, Ellis H (eds) Maingot's abdominal operations. Appleton & Lange, London, pp 256–260

    Google Scholar 

  • Abramov D, Jeroukhimov I, Yinnon AM, Abramov Y, Avissar E, Jerasy Z, Lernau O (1996) Antibiotic prophylaxis in umbilical and incisional hernia repair: a prospective randomised study. Eur J Surg 162: 945–948

    Google Scholar 

  • Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1: 15–21

    Google Scholar 

  • Apfelberg DB, Maser MR, Lash H (1979) Two unusual umbilicoplasties. Plast Reconstr Surg 64: 268–270

    Google Scholar 

  • Askar OM, (1978) A new concept of the aetiology and surgical repair of paraumbilical and epigastric hernias. Ann R Coll Surg Engl 60: 42–48

    Google Scholar 

  • Askar OM (1984) Aponeurotic hernias. Recent observations upon paraumbilical and epigastric hernias. Surg Clin North Am 64: 315–333

    Google Scholar 

  • Azurin DJ, Go LS, Arroyo LR, Kirkland ML (1995) Trocar site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 61: 718–720

    Google Scholar 

  • Baccari EM, Breiling B, Organ CH Jr. (1971) A study of the maturity onset of adult umbilical hernia. Am Surg 37: 385–388

    Google Scholar 

  • Baron HC (1960) Umbilical hernia secondary to cirrhosis of the liver. N Engl J Med 263: 864

    Google Scholar 

  • Belghiti J (1991) Traitement chirurgical de la hernie ombilicale du cirrhotique. In: Encycl Méd Chir, Techniques chirurgicales-Appareil digestif. Paris, 40146: pp 1–6

    Google Scholar 

  • Belghiti J, Desgrandchamps F, Farges O, Fekete F (1990) Herniorrhaphy and concomitant peritoneovenous shunting in cirrhotic patients with umbilical hernia. World J Surg 14: 242–246

    Google Scholar 

  • Belghiti J, Durand F (1997) Abdominal wall hernias in the setting of cirrhosis. Semin Liver Dis 17: 219–226

    Google Scholar 

  • Bryant WM, Griffen WO Jr (1969) Umbilical hernia and gallbladder disease. Am J Surg 117: 653–655

    Google Scholar 

  • Celdran A, Bazire P, García-Urena MA, Marijuan JL (1995) H-hernioplasty: a tension-free repair for umbilical hernia. Br J Surg 82:371–372 Celdrán A, Garcia Urena MA, Bazire P, Marijuan JL (1996) The use of omentum in mesh repair of ventral hernias. Am Surg 62: 443–445

    Google Scholar 

  • Celdrán A, Castell J (1997) Hernia umbilical. In: Porrero JL (ed) Cirugía de la pared abdominal. Masson, Barcelona, pp 202–207

    Google Scholar 

  • Chapman CB, Snell AM, Rowntree LG (1981) Decompensated portal cirrhosis. Report of one hundred and twelve cases. Clinical features of the ascitic stage of cirrhosis of the liver. Am J Gastroenterol 80: 237–244

    Google Scholar 

  • Chevrel JP (1996) Inguinal, crural, umbilical hernias. Physiopathology, diagnosis, complications, treatment. Rev Prat 46: 1015–1023

    Google Scholar 

  • Chevrel JP, Hament JB (1990) Les éventrations de la paroi abdominale. Masson, Paris pp 108

    Google Scholar 

  • Chu KM, McCaughan GW (1995) Iatrogenic incarceration of umbilical hernia in cirrhotic patients with ascites. Am J Gastroenterol 90: 2058–2059

    Google Scholar 

  • Corlett MP, Mittal V, Evans DS (1994) Subumbilical hernia following laparoscopic cholecystectomy. Br J Surg 81: 777–778

    Google Scholar 

  • Corres J (1969) New technic for the surgical treatment of umbilical hernia. Ginecol Obstet Mex 26: 283–293

    Google Scholar 

  • DeBord JR (1998) The historical development of prosthetics in hernia surgery. Surg Clin North Am 78: 973–1006

    Google Scholar 

  • Falla A (1987) Umbilical hernia repair. JAMA 258: 2588

    Google Scholar 

  • Farris JM, Smith GK, Beattie AS (1959) Umbilical hernia: an inquiry into the principle of imbrication and a note on the preservation of the umbilical dimple. Am J Surg 98: 236–242

    Google Scholar 

  • Garda MA, Velasco M, Carnero F, Sancho E, Aljama P, Rodríguez A (1998) Systematic use of polypropylene mesh in the surgical repair of all umbilical hernias. In: Bismuth H, Galmiche JP, Huguier M, Jaeck D (eds) 8th World Congress of the International Gastro-Surgical Club. Monduzzi editore, Bologna, pp 631–634

    Google Scholar 

  • García MA, Rico P, Seoane J (1994) Hernia umbilical del adulto. E.esultados a largo plazo en pacientes operados de urgencia. Cir Esp 56: 302–306

    Google Scholar 

  • Gianetta E, de Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G (1997) Hernia repair in elderly patients. Br J Surg 84: 983–985

    Google Scholar 

  • Gibson LD, Gaspar MR (1959) A review of 606 cases of umbilical hernia. Surg Gynecol Obstet 109: 313–317

    Google Scholar 

  • Gouillat C (1993) Inguinal, crural and umbilical hernia. Physiopafhology, diagnosis, complications, treatment. Rev Prat 43: 1008–1012

    Google Scholar 

  • Harmel RP (1989) Umbilical hernia. In: Nyhus LM, Condon RE (eds) Hernia. J.B. Lippincott, Philadelphia, pp 347–352

    Google Scholar 

  • Heydorn WH, Velanovich V (1990) A five-year U.S. Army experience with 36,250 abdominal hernia repairs. Am Surg 56: 596–600

    Google Scholar 

  • Hjaltason E (1981) Incarcerated hernia. Acta Chir Scand 147: 263–267

    Google Scholar 

  • Itoh Y, Arai K (1992) Umbilical reconstruction using a cone-shaped flap. Ann Plast Surg 28: 335–338

    Google Scholar 

  • Jackson OJ, Moglen LH (1970) Umbilical hernia. A retrospective study. Calif Med 113: 8–11

    Google Scholar 

  • Kirkpatrick S, Schubert T (1988) Umbilical hernia rupture in cirrhosis with ascites. Dig Dis Sci 33: 762–765

    Google Scholar 

  • Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164: 965–969

    Google Scholar 

  • Lemmer JH, Strodel WE, Eckhauser FE (1983) Umbilical hernia incarceration: a complication of medical therapy of ascites. Am J Gastroenterol 78: 295–296

    Google Scholar 

  • Lemmer JH, Strodel WE, Knol JA, Eckhauser FE (1983) Management of spontaneous umbilical hernia disruption in the cirrhotic patient. Ann Surg 198: 30–34

    Google Scholar 

  • Lichtenstein IL, Herzikoff S, Shore JM, Jiron MW, Stuart S, Mizuno L (1970) The dynamics of wound healing. Surg Gynecol Obstet 130: 685–690

    Google Scholar 

  • Luijendijk RW, Lemmen MH, Hop WC, Wereldsma JC (1997) Incisional hernia recurrence following ≪vest-over-pants≫ or vertical Mayo repair of primary hernias of the midline. World J Surg 21: 62–65

    Google Scholar 

  • Maniatis AG, Hunt CM (1995) Therapy for spontaneous umbilical hernia rupture. Am J Gastroenterol 90: 310–312

    Google Scholar 

  • Mawera G, Muguti GI (1994) Umbilical hernia in Bulawayo: some observations from a hospital based study. Cent Afr J Med 40: 319–323

    Google Scholar 

  • Mayo WJ (1901) An operation for the radical cure of umbilical hernia. Ann Surg 34: 276–280

    Google Scholar 

  • Mittelstaedt WE, Rebelatto FJ, Uchoa MC, Souza JFT, Pires PWA, Speranzini M, Oliveira MR (1988) Umbilical hernia in adults. Review of 291 cases treated at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. Rev Hosp Clin Fac Med Sao Paulo 43: 51–58

    Google Scholar 

  • Morgan WW, White JJ, Stumbaugh S, Haller JA Jr (1970) Prophylactic umbilical hernia repair in childhood to prevent adult incarceration. Surg Clin North Am 50: 839–845

    Google Scholar 

  • Nassar AH, Ashkar KA, Rashed AA, Abdulmoneum MG (1997) Laparoscopic cholecystectomy and the umbilicus. Br J Surg 84: 630–633

    Google Scholar 

  • O'Hara ET, Oliai A, Patek AJ, Jr., Nabseth DC (1975) Management of umbilical hernias associated with hepatic cirrhosis and ascites. Ann Surg 181: 85–87

    Google Scholar 

  • Paul A, Korenkov M, Peters S, Kohler L, Fischer S, Troidl H (1998) Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias. Eur J Surg 164: 361–367

    Google Scholar 

  • Peacock EE, (1978) Biology of hernia. In: Nyhus LM, Condon RE (eds) Hernia. Lippincot, Philadelphia, pp 79–93

    Google Scholar 

  • Pescovitz MD, (1984) Umbilical hernia repair in patients with cirrhosis. No evidence for increased incidence of variceal bleeding. Ann Surg 199: 325–327

    Google Scholar 

  • Pilling GP (1978) Umbilical hernia. In: Nyhus LM, Condon RE (eds) Hernia. Lippincot, Philadelphia, pp 362–367

    Google Scholar 

  • Premont M, Clotteau JE (1989) Hernie ombilicale de l'adulte. In: Encycl Méd Chir. Techniques chirurgicales-Appareil digestif. Paris, 40145: pp 1–9

    Google Scholar 

  • Quénu J, Perrotin J (1955) Traité de technique chirurgicale. Masson, Paris, pp 151–164

    Google Scholar 

  • Read RC (1998) Metabolic factors contributing to herniation. Hernia 2: 51–55

    Google Scholar 

  • Runyon BA, Juler GL (1985) Natural history of repaired umbilical hernias in patients with and without ascites. Am J Gastroenterol 80: 38–39

    Google Scholar 

  • Stone IK, von Fraunhofer JA, Masterson BJ (1986) The biomechanical effects of tight suture closure upon fascia. Surg Gynecol Obstet 163: 448–452

    Google Scholar 

  • Utrera A, Carranza G (1997) Hernia umbilicalepigástrica. Técnica de la espiral. In: Porrero JL (ed) Cirugía de la pared abdominal. Masson, Barcelona, pp 215–218

    Google Scholar 

  • Wagh PV, Leverich AP, Sun CN, White HJ, Read RC (1974) Direct inguinal herniation in men: a disease of collagen. Surg Res 17: 425

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Puerto Real University Hospital, Cra Nacional IV, Km 665, 11510, Puerto Real, Spain

    M. Velasco, M. A. Garcia-Ureña, V. Vega & F. J. Carnero

  2. Department of Surgery, 12 de Octubre University Hospital, Cra de Andalucía Km 5.4, 28041, Madrid, Spain

    M. Hidalgo

Authors
  1. M. Velasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. A. Garcia-Ureña
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Hidalgo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. J. Carnero
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Velasco, M., Garcia-Ureña, M.A., Hidalgo, M. et al. Current concepts on adult umbilical hernia. Hernia 3, 233–239 (1999). https://doi.org/10.1007/BF01194437

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01194437

Key words

Search

Navigation