Umbilical hernia surgery is indicated when umbilical hernia is larger than 2cm, “elephant’s trunk” appearance, does not spontaneously close by 5 to 6 years of age, symptomatic, strangulation, or increases in size after the age of 1 to 2 years. Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure. Mesh implantation include bridging the defect and placing a preperitoneal mesh with suture repair. Postoperative recovery is usually uneventful. Recurrence is seen in patients with elevated intra-abdominal pressures. Laparoscopic technique is reserved for large defects or recurrent umbilical hernias.

• Umbilical hernia surgery is indicated in the following cases:^[1][2][3][4]
  • Larger than 2 cm
  • “Elephant’s trunk” appearance
  • Did not spontaneously close by 5 to 6 years of age
  • Symptomatic
  • Strangulation
  • Hernia increases in size after the age of 1 to 2 years

Surgery for umbilical hernia is as follows:^{[1][2][5][6][7]}

• Surgical repair for an uncomplicated umbilical hernia is done under general anesthesia as an outpatient procedure.
  • Small curvilinear incision is made into the skin crease of the umbilicus
  • Sac is dissected free from the overlying skin and the fascial defect
    • Ensures that no abdominal content are present prior to the repair
  • Fascial defect is repaired with absorbable, interrupted sutures
  • Skin is closed using subcuticular sutures with monocryl or vicryl
• In adults
  • Small defects are closed after separation of the sac from the overlying umbilicus and surrounding fascia.
  • Defects greater than 3 cm are closed using prosthetic mesh.
  • No data shows clear advantages of one technique over another.

• Mesh implantation include bridging the defect and placing a preperitoneal mesh with suture repair.
• Laparoscopy is reserved for large defects or recurrent umbilical hernias.
• Postoperative recovery is usually uneventful.
• Recurrence is seen in patients with elevated intra-abdominal pressures.

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