Umbilical and midline hernia
Introduction
Umbilical hernia as well as other abdominal midline hernias (epigastric, supraumbilical, subumbilical, hypogastric, subxiphoid) originate from disruptions and interruptions of the connective tissue that makes up the linea alba. The linea alba is the structure that holds the two rectus abdominis muscles together and is therefore the supporting column of the abdominal wall.
Often in women, umbilical and midline hernias are associated with rectus abdominis diastasis and may be a diagnostic warning. Also in men there is frequently an association between umbilical hernias and inguinal hernias.
Umbilical hernia: signs and symptoms
Umbilical hernias as well as hernias of the median line are easily diagnosed, there is an evident swelling at the level of the umbilicus and with time it changes shape becoming everted. Also with time, the skin of the umbilicus can take on a thinned and painful appearance. There may be pain and in severe cases the intestine may become involved causing transit disorders.
Umbilical hernia surgery
Techniques range from traditional ones involving an over-under umbilical surgical incision to the newer minimally invasive techniques.
In our experience the use of robotics has allowed the repair of this type of hernia in an optimal way. The operation is performed through three small access ways and in the same operating session it is generally possible to repair any diastasis or associated inguinal hernias.
Generally we use the access route R-TAPP which allows to work easily with the latest generation of materials such as semi-absorbable and self-fixing nets, placing them in a very stable way in the space. pre-peritoneal.
Since the reconstruction is posterior to the muscle-tendon barrier, it proves to be externally solid during physical exertion.
Due to the fact that there are no tucks or mesh anchors the surgery has a low level of pain.
The reconstruction is placed in the preperitoneal space, so there is no contact with the inside of the abdominal cavity and viscera for maximum protection and safety.
Umbilical hernia, abdominal band and sports
The containing abdominal bandage is a valid help in the post-operative period, favoring the compression and healing of the tissues just operated, but it is not decisive if used as a stand-alone element in the absence of a surgical repair.
Regarding physical activity in persons with umbilical or midline hernia, one must consider that any increase in abdominal pressure is potentially aggravating the condition.
Exercise in the presence of midline or umbilical hernias is therefore relatively contraindicated, especially abdominal crunches and squats should be avoided.
Instead, it will be possible to resume normal physical activity and any sport after adequate surgical resolution and convalescence.
Other hernias and laparoceles
This chapter will list less frequently encountered, but no less important, hernias.
Spigelian hernia
Among the rare hernias there is undoubtedly hernia of Spigelio, this hernia occurs in a distinct region of the abdominal wall, lateral to the rectus muscles at the line semilunar of Douglas.
Its recognition can be difficult because the hernia often makes its way posteriorly without deforming the anterior fasciae, thus being barely visible or externally palpable.
The therapeutic approach is anatomically unfavorable to traditional surgery, which relies on incision of tissue layers starting from superficial to deep.
Therefore, due to the anatomical characteristics of Spigelio's hernia we have generally preferred, in our clinical practice, the robotic access route R-TAPP exploiting its obvious advantages. In fact, the work is performed directly in the appropriate anatomical plane without having to sacrifice the healthy superficial layers.
Laparoceles
For Incisional hernia refers to a herniated defect originating through a previous surgical incision.
More frequently, we can find laparoceles involving the midline, as most surgical incisions for abdominal surgeries occur right on the midline.
We can further subdivide midline laparoceles into supra- or subumbilical and further into mono- or pluriconcamerati.
Less frequently encountered are subscostal la paroceles or suprapubic laparoceles, which due to their proximity to bony prominences are sometimes referred to as border laparoceles.
