Zhitny Vladislav Pavlovich, Young Jake Patrick, Stile Frank
New York University, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York City, NY, USA.
University of Utah, Department of Biology, Salt Lake City, UT, USA.
Ann Med Surg (Lond). 2022 Sep 22;82:104731. doi: 10.1016/j.amsu.2022.104731. eCollection 2022 Oct.
Umbilical hernias are found in 2% of the American adult population with increasing prevalence in overweight and multiparous women. A mesh repair is considered to be a suitable option for those desiring non-cosmetic surgical repair. Despite the mesh plug's reported value in reduction of the recurrence of umbilical hernia from 11% to 1%, there is an increased risk in de-vascularizing the umbilicus with its use.
We present a case which avoids fascial incisions near the umbilicus, thus preserving the blood supply employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication.
Hernia repair can be associated with a host of issues, minor and major, including regional tissue ischemia and the distortion of natural anatomy, likely due to ischemia of the epigastric vessels. Abdominoplasty is a suitable option for patients with redundancy of the abdominal skin and laxity abdominal wall musculature. Abdominoplasty has excellent exposure and correction of abdominal wall hernias. This "anatomic repair" employing sutures to reduce the small abdominal wall defect which is then further reinforced by overlying rectus muscle plication can be used in place of a mesh overlay for the purposes of umbilical hernia repair especially when the hernia may be asymptomatic.
Abdominoplasty uniquely allows for an open hernia repair when anticipated or discovered at the time of surgery and is considered a true anatomical repair of an umbilical hernia which does not necessitates the use of foreign materials.
脐疝在美国成年人群中的发病率为2%，在超重和经产妇中患病率呈上升趋势。对于那些希望进行非美容性手术修复的患者，网状修复被认为是一种合适的选择。尽管据报道网状补片可将脐疝复发率从11%降至1%，但其使用会增加脐部血管化减少的风险。
我们报告一例避免在脐部附近进行筋膜切口的病例，从而通过缝合保留血供，以减少小的腹壁缺损，然后通过覆盖腹直肌折叠进一步加强修复。
疝修补可能会伴有一系列或轻或重的问题，包括局部组织缺血和自然解剖结构的扭曲，这可能是由于腹壁上血管缺血所致。腹壁成形术是治疗腹部皮肤冗余和腹壁肌肉松弛患者的合适选择。腹壁成形术在暴露和矫正腹壁疝方面效果极佳。这种“解剖修复”通过缝合减少小的腹壁缺损，然后通过覆盖腹直肌折叠进一步加强，可用于替代网状覆盖物进行脐疝修补，特别是当疝可能无症状时。
腹壁成形术在手术时预期或发现脐疝时可独特地进行开放性疝修补，被认为是真正的脐疝解剖修复，无需使用外来材料。
