The Risk of Anterior Abdominal Wall Adhesions in Patients with Previous Umbilical Hernia Repair.

The incidence of umbilical hernia may be increased in certain populations during infancy. Many procedures to repair such defects are thus performed during early childhood. Patients may present for adult surgery with minimal or no recollection of these surgeries and with only a small infra-umbilical incision which appears remarkably similar to an incision for laparoscopy. We proposed to evaluate the risk of adhesions to the area of the umbilicus and anterior abdominal wall in patients presenting for laparoscopic surgery. Eight patients with documentable umbilical hernia repair comprise this study. One patient had undergone two procedures. To best evaluate the umbilicus, initial trocar insertion was made in the left upper quadrant, 2 cm below the costal margin in the mid-clavicular line. Findings demonstrated significant bowel and omental adhesions to the area of the umbilicus in all but one patient. Interestingly, one patient had previously undergone an unsuccessful attempt at Veress needle placement and open laparoscopy. This patient had massive bowel adhesions to the entire umbilical region. In all but the one case, trocar or Veress needle insertion would have likely caused significant tissue or visceral injury. No complications occurred in this series. In conclusion, patients with previous umbilical hernia repair may be at higher risk for adhesive disease to this region. Appropriate bowel preparation prior to surgery and site selection for trocar entry may aid in decreasing the risk of visceral injury.