Plastic surgery without implant
The edges of the aponeurosis are sutured overlapping each other (Mayo duplication) with non-absorbable sutures - with a small defect this creates sufficient strength. The method is chosen by young patients and women planning pregnancy (the mesh in this area can limit the stretching of the wall), as well as when refusing an implant. Conditions for success: small defect, strong aponeurosis, normal BMI and discipline of restrictions - bandage for 6 weeks and abstinence from heavy lifting for 2 months while the scar is forming. For large defects, it is more honest to plan the mesh right away.
Indications
- umbilical hernia in adults - planned treatment;
- pain, episodes of irreducibility - risk of strangulation;
- small defects up to 1.5–2 cm - plastic surgery without mesh is possible;
- defects larger than 1.5-2 cm and relapses - plastic surgery with a mesh implant.
Choice of plastic surgery
For small defects in young patients with a strong aponeurosis, plastic surgery using one’s own tissues (according to Mayo/Sapezhko) is acceptable - without an implant, but with a longer limitation of loads; for a defect of 1.5–2 cm, tissue weakness, obesity and relapses, the mesh is the standard: it covers the ring with a margin and reduces relapses from 15–30% to 2–5%. Open access through a small incision is optimal for a typical umbilical hernia; The laparoscopic option is considered in combination with diastasis and other defects (see the laparoscopic plastics page in the same group “Options and prices”).
