Umbilical hernias commonly often occur directly after birth during infancy and are the result of the abdominal wall around the navel not developing completely. This gap in the abdominal wall allows intestines and parts of organs from inside the abdomen to enter the hernial sac.
Umbilical hernias are common in babies. They usually resolve without problems and do not require any treatment. During the first 2 years of life, they often spontaneously resolve as the increased abdominal muscle mass closes the gap.
In adults, most umbilical hernias are acquired. They can be caused by increased pressure in the abdominal cavity. This may occur for a number of reasons - being overweight, for example, having ascites or being pregnant. Constant straining due to stubborn bowels / constipation can also lead to an umbilical hernia.
For larger fascia defects (> 1.5 cm) or for patients with a relevant risk profile, additional mesh reinforcement (= mesh augmentation) should be used. This can be performed as an onlay, inlay, sublay, pre-peritoneal or from inside as an open or laparoscopic IPOM (Intra-Peritoneal Onlay Mesh-plasty). If mesh augmentation of the abdominal wall is indicated, we generally prefer to position the mesh outside of the abdominal cavity (extra-peritoneal). This prevents any complications associated with the mesh, such as adhesions between the mesh prosthesis and the abdominal organs. We believe the pre-peritoneal space, which lies in the layer between the peritoneum and the fascia of the abdominal wall, to be the "ideal" location.
In most cases, simple blunt pushing will create an adequately sized mesh bed, allowing the mesh to extend by at least 2-3 cm beyond the fascia defect. The mesh is then placed between the peritoneum, which continues to act as a natural protective barrier for the intestines, and the posterior abdominal wall fascia, and is only secured in position in places with single button sutures using absorbable suture material. On top of this, the fascia defect is closed with continuous non-absorbable sutures (e.g. Prolene 2-0). By using large-pored, reduced-surface mesh prostheses, the amount of foreign body material implanted and therefore the body's reaction to foreign bodies can be reduced as much as possible.
This surgical technique is known as Pre-peritoneal Umbilical Mesh Plasty, or "PUMP repair" for short. PUMP repair = Pre-peritoneal Umbilical Mesh Plasty