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Forum Name: Surgery Topics

Question: Ventral or Umbilcal Hernia repair??


 HooDooMan - Sun Dec 06, 2009 5:41 am

In Oct 08 I had gone in for a hernia repair. The hernia was located about 3/4 inch above my belly button. the surgery went fine and I went home the same day. He said I might have some pain for the next few weeks while it healed. But it may take a couple of months. For the next few months I was still in the same pain as I was before the surgery. I went back in to see him 4 months after the surgery because it just wasnt feeling any better. He said the mesh looks to be holding really well. Then said because my belly button was now pushed in this was one of the ways he could tell. He then said I need more time to heal.
5 months went by and I went back because the pain was still the same and sometime even worse. I had to wear a large back brace that held my stomach in just to make it through the day nearly everyday after the surgery. Well when I went back he once again said that my belly button was still in an didnt understand why I was still in pain. He had me lay on the table and I showed him the location above my belly buttom where the pain was. He acted a little strange once he started feeling the hernia and then said I would need to have another repair. The way he had acted didnt sit well with me! I couldnt do a surgery right away like he wanted me to and I wasnt feeling comfortable about the way he acted.
I took some time and recently found another doctor and had a consultation. He said it was a little strange where my incision was from my last surgery. The incision is located at the bottom of my belly botton. He said most ventral hernia surgeries based on where my hernia was would have an incision right above the hernia. Not at the bottom of my belly button which indicates to him it would have been a umbilical repair. He did say it was possible to do a ventral from that spot but wouldnt be likely since I'm not a 6 pack stomach model.
So im now wondering what are the chances that he did an umbilcial surgery and not a ventral? Do many surgeons preform the ventral repair by going in at the bottom of the belly button? I am getting another consultation from another surgeon on Monday and a CT scan to find the location of the first mesh but these questions are just eating at me, making it hard to sleep! I do have the medical notes from the surgery that I can type out on my next post if it helps determine what he did. I cant tell since its in medical lingo. Thanks for helping out!
 Dr.M.Aroon kamath - Fri Dec 11, 2009 12:23 am

User avatar Hi,
An 'epigastric' hernia occurs anywhere between the umbilicus (belly button) and the xiphoid process (a small bone attached at the lower end of the breast bone).

A 'True' umbilical hernia occur through the umbilicus.

A 'Para-umbilical" hernia occurs generally just above the umbilicus (but,can also occur occasionally below or to one side of the umbilicus).

You describe the hernia that you had (i note that you have not named it) as "was located about 3/4 inch above my belly button".

A hernia that close to the umbilicus could have been a very low epigastric hernia or a para-umbilical hernia.

Umbilical and para-umbilical hernias are generally repaired
(in 'open' repairs) via a curved infra-umbilical incision.

An epigastric hernia that close to the umbilicus as you describe (how big or how small was it?), could be repaired either by an infra-umbilical approach or an incision placed immediately over the hernia.

Some of the problems in repairing such low epigastric hernias through an incision placed immediatly over the hernia are...
- that it makes it technically difficult to raise the lower flap as the umbilicus will tend to come in the way,
- vascularity of the lower flap(which would be thin and devoid of fat (around the umbilicus) may be compromised,
- a 'dead space' may result leading to infections and more importantly,
- placing an adequate sized mesh and fixing the mesh satisfactorily may be difficult (leading to increased chances of recurrences).


If one is not planning to do a mesh repair and only a anatomical closure is planned,
then an incision placed immediately over the hernia may be adequate.


Which incision to employ for a very low epigastric hernia will no doubt depend upon an individual surgeon's preferences.
Best wishes!

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