Modern Surgical Methods of Umbilical Hernia Repair: Literature Review

Abstract

INTRODUCTION: In this review, methods of open and laparoscopic surgery of the umbilical hernia are described. Use of particular methods is substantiated depending on the size of the hernial orifice, the presence of hernia strangulation, diastasis of the abdominal rectus muscles, comorbidity, available technical equipment. Statistical data of complications, recurrences and of their prevention available in the literature are evaluated. The search for information was performed in electronic libraries: Pubmed, Cyberleninka. The inclusion time interval is 10 years. The keywords used in the search: umbilical hernia, IPOM, eTEP, (E)MILOS, SCOLA, tension method of hernioplasty, complications. The most important modern methods using endovideosurgical access are: laparoscopic IPOM(+), eTEP, (E)MILOS, SCOLA. Use of tension plasty can be justified in case of strangulation, but, here, recurrences are more common. The IPOM method has a number of disadvantages (adhesions, chronic pain, chronic seroma, recurrences), which make its use controversial and needing additional research. The eTEP-TAR, eTEP-RS methods are used in pronounced diastasis of the rectus muscles. The eTEP-RS method is convenient in simultaneous surgery of inguinal hernias. The eTEP-TAR method is used in case of large diameter of hernial orifice (5–12 cm), and suggested width of the retromuscular space less than 5 cm. The MILOS, EMILOS methods are used in case of primary, postoperative umbilical and epigastric hernias. With this, the frequency of complications is less relative to Sublay, IPOM. CONCLUSION: Each method of umbilical hernioplasty is based on certain factors taken into: diastasis of rectus muscles, size of hernial orifice, existence of strangulation, availability of equipment and materials, comorbid pathologies. The variety of manipulations determines personal approach in surgery of umbilical hernias. The modern tendencies in this field are minimization of injury rate in surgical approach in use of endovideosurgical access and attempts to perform simultaneous recovery of the muscular aponeurotic apparatus of the abdominal wall through elimination of diastasis of rectus muscle. Potentials of the modern high-tech medicine permit to significantly reduce the frequency of complications and recurrences in case of large, medium and complicated umbilical hernias.