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

With an incarceration rate of 30% and a mortality of up to 15%, there is no doubt about the indication for surgical repair of umbilical hernias. One exception are small umbilical hernias with a fascial defect of ≤ 0.5 cm and thus a low risk of incarceration.

Small hernias / up to 2 cm

• Open repair
• No mesh required
• Gold standard: Spitzy repair

Moderate hernias / 2–4cm

• Open repair
• Mesh recommended
• Intraperitoneal mesh repair with anchor sutures
• PUMP technique

Large hernias / > 4 cm

• Open or laparoscopic repair
• Mandatory mesh!
• In large defects PUMP repair is not always indicated.
• IPOM
• Sublay technique

This presentation describes the

open preperitoneal umbilical mesh plasty = PUMP-Repair.

Caution is advised in:

• Cirrhosis of the liver with ascites
• Advanced malignancy
• Cardiopulmonary risk, e.g., heart failure (NYHA III and NYHA IV)

Medical history

• Duration and progression of hernia
• If rapidly increasing in size, rule out underlying intraabdominal disease!

Clinical examination

• Palpation with patient standing and supine, possibly Valsalva maneuver

Ultrasound of the abdominal wall

• Entire midline from xyphoid to the pubic symphysis
• Structure of the linea alba: Additional fascial defects, diastasis recti abdominis

• Depilation of the surgical field
• Marking the location of the hernia
• Patient fasting > 6 hours, no liquids > 3 hours

• Secondary healing
• Recurrence
• Hematomas, secondary bleeding
• Bowel injury
• Injury to adjacent structures
• Postoperative ileus
• Infection
• Thrombosis
• Embolism
• Reoperation
• Temporarily impaired postoperative exercise tolerance
• Chronic pain syndrome
• Umbilical skin necrosis