What are the surgical treatment options for different types of abdominal hernias?

Updated: Jul 23, 2019
  • Author: Assar A Rather, MBBS, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Surgical approaches to other hernia types may vary, as follows:

  • Umbilical hernia - After exposure of the umbilical sac, a plane is created to encircle the sac at the level of the fascial ring, and the defect is closed transversely with interrupted sutures; if the defect is very large (>2 cm), mesh may be required
  • Epigastric hernia - A small vertical incision directly over the defect is carried to the linea alba, and incarcerated preperitoneal fat is either excised or returned to the properitoneum; the defect is closed transversely with interrupted sutures
  • Spigelian hernia - A transverse incision over the hernia to the sac allows dissection to the neck, and clean approximation of the internal oblique muscle and the transversus abdominis followed by closure of the external oblique aponeurosis completes the repair
  • Interparietal hernia - Large interparietal hernias require mesh or component separation technique
  • Supravesical hernia - The standard techniques for inguinal and femoral hernias are used, usually via a paramedian or midline incision
  • Lumbar hernia - A skin-line oblique incision is made from the 12th rib to the iliac crest; a layered closure or mesh onlay for large defects is successful
  • Obturator hernia - Generally approached abdominally and often amenable to laparoscopic repair; mesh closure is necessary for a tension-free repair
  • Sciatic hernia - A transperitoneal approach is used in the event of incarceration; a transgluteal repair can be used if the diagnosis is established and the intestine is clearly viable
  • Perineal hernia - A transabdominal approach with prosthetic closure is preferred; a combined transabdominal-perineal approach can also be used
  • Gastroschisis and omphalocele - Primary closure of fascia and skin is usually best; nonoperative management of gastroschisis (plastic closure) is an alternative to conventional primary operative closure or staged silo closure
  • Femoral hernia - A standard Cooper ligament repair, a preperitoneal approach, or a laparoscopic approach may be used; the procedure includes dissection and reduction of the hernia sac and obliteration of the defect in the femoral canal by approximating the iliopubic tract to the pectineal (Cooper) ligament or by using a mesh

See Treatment and Medication for more detail.


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