Surgical treatment of umbilical hernias with preservation of cosmetic effect

Abstract

The aim of the work: to develop a method for surgical treatment of umbilical hernias with preservation of the cosmetic effect.

Materials and Methods. In the Surgical Department of the Central City Clinical Hospital of Ivano-Frankivsk for 2016–2018, 267 patients with umbilical hernias were operated on. 230 patients underwent traditional surgical interventions according to the Mayo technique, Sapezhko or with the use of allografts. 37 patients used the original method of surgery with preservation of the navel, which was developed in the clinic. Groups of patients by age, gender, type and duration of pathology were comparable.

Results and Discussion. The essence of the original methodology of the operation was as follows: an incision of the skin and subcutaneous fatty tissue before the aponeurosis is carried out through the navel vertically with respect to the human body in an upright position. A hernial sac was isolated, dissected, its contents were immersed in the abdominal cavity. The hernial sac was bandaged at the base and the peritoneum was cut off or sutured with a circumferential suture. Thoroughly cleansed the enlarged umbilical ring and part of the adjacent aponeurosis of adipose tissue and performed hernia repair using Mayo or other methods. After that, if necessary, part of the navel skin was carved if it deformed, and an original cosmetic immersion suture was applied, which captured the dermal part of the skin and aponeurosis. The knot was tied under the skin. The latter was sewn up with a cosmetic seam. Sometimes the skin suture was strengthened with 1–2 knotted sutures. The proposed method for surgical treatment of umbilical hernias of small diameter does not significantly affect the duration of the operation and even a few minutes shorter. So, the total indicator of the duration of the operation by the traditional method was (56.4±10.5) minutes, and when performing the original method (51.4±) 7.7 minutes. The groups of ope­rated patients did not differ in the number of wound complications. This also applies to the length of hospital stay – (3.1±1.1) bed/day. The proposed method for surgical treatment of umbilical hernias of a small size (2–3cm) helps to preserve the natural forms of the abdomen by restoring the navel and eliminating its deforming part.