Gold standard for this operation is the Spitzy repair by direct suture as described in this article.
Indications:
- Diameter of hernia orifice < 3cm
- Symptomatic umbilical hernia, incarceration
- In newborns umbilical hernia is physiological until umbilical scarring is complete. Since in 98% of cases the umbilical hernia will close spontaneously by the end of the 2ndyear (very little danger of incarceration during this time) surgery is not indicated before that time.
Contraindications:
- Ascites
- Peritoneal metastasis
- General inoperability
The recurrence rate correlates with:
- BMI <30 recurrence rate: 8%, BMI>30 recurrence rate: 32%
- Diameter of hernia orifice: The recurrence rate in hernia orifices up to 1cm was 6.3%; in diameters 1-2cm 4.1%; in hernia orifices 2-3cm 14.3%; in diameters 3-4cm 25.0%; and in hernia orifices larger than 4cm 54.5%.
Closure of the hernia orifice with mesh augmentation is indicated in patients with a BMI >30 and a hernia orifice > 3cm.