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10
Treatment of Umbilical and Ventral Hernias During Abdominoplasty

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Background

-Over 1 million hernia repairs in USA per year
-Approx. 20-25% of hernias are UH/VH (including incisional)
-For UH/VH > 1 cm – laparoscopic repair treatment of choice using mesh
-Tension free closure is key
-Data for incidence of UH/VH found incidentally at abdominoplasty is lacking

Treatment

-Any primary UH/VH less than 3 cm diameter can be safely repaired primarily if diastasis repair is involved
-If no diastasis repair, UH/VH < 1 cm can generally be repaired safely with primary repair
-Thorough H&P should discover most hernias at initial consultation
-Incisional hernias =treated with greater caution due to underlying adhesive disease

Technique

-Free soft-tissue from underlying rectus fascia around sac
-Dissect sac from overlying fascia
-Reduce contents, sac does not need to be incised, but no harm if it is
-Use non-absorbable suture (0 Ethibond preferred)
-ALWAYS place interrupted suture
-Repair diastasis in usual fashion

Pearls

-Use caution in pts with incisional hernias
-DO NOT liposuction abdomen prior to hernia repair
-If bowel exposed, may lead to ileus
-Consider pre-op CT if hernia found on PE
-When in doubt – refer to general surgeon for repair prior to abdominoplasty
-Tension free is KEY
-We have not had a recurrence in 11 years
-PRIMUM NON NOCERE
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