Ventral Hernia Repair - Small Umbilical Hernia without mesh by George Crawford, MD

Operative Steps

Access is generally obtained through an incision in the left upper quadrant. Usually, a 5 mm trocar is used to enter the abdomen if laparoscopic assistance is needed.
The abdomen is insufflated to visualize the ventral hernia defect.
NOTE: Once visualized and safe, an incision can be made over the ventral defect. If intra-abdominal contents cannot be reduced under direct visualization, then additional 5 mm trocar can be placed to facilitate.

An incision is made over the ventral hernia. The subcutaneous tissue is dissected.
The hernia sac is dissected out bluntly and exposed.
Once completely exposed, the hernia sac is excised at the base of the fascial defect. The fascia is exposed circumferentially around the defect. For small defects, suture such as Vicryl™ Plus Antibacterial suture, Prolene™ Polypropylene, or Ethibond EXCEL™ Polyester may be used to re-approximate the facia. For larger defects, a suture passer technique may be utilized.
If this is an umbilical hernia, and the umbilicus has been mobilized away from the facia, it may be reapproximated, such as a size 0-Coated Vicryl™ Plus Antibacterial suture.

The trocars are removed. The wounds are closed using synthetic absorbable suture, such as Monocryl™ Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND ™ PRINEO™ Skin Closure System or any appropriate dressing.