Umbilical hernia repair, open, preperitoneal umbilical mesh plasty ("PUMP”-Repair)

Semicircular skin incision along the right lateral margin of the umbilicus.

With delicate dissecting scissors free the hernia sac all around from its adhesions with the subcutaneous tissue without opening it.

360° epifascial dissection with exposure of the fascial margins, followed by freeing the hernia sac from these margins.

Carefully free the peritoneum digitally from the posterior lamina of the fascia; this will open the preperitoneal space 360° around the fascial defect over a length of 3–5cm.