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How can supraumbilical and umbilical ventral hernias be treated?

Thursday, 30 June 2011
Answered by: Prof Suneet Sood
Consultant Surgeon, Malaysia
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Q. My 35 years old friend underwent a CT scan, which shows that she has supraumbilical and umbilical ventral hernias. How can this be managed? She just had surgery to repair a ventral hernia.

A.  The diagnosis of an umbilical hernia, supraumbilical hernia, or of almost any other abdominal wall ventral hernia is "clinical", which means that it does not depend on a CT scan or on any other investigation.

Presuming that ventral hernia, which was just repaired, was infra-umbilical, meaning below the umbilicus: If she had a ventral hernia that needed repair, the doctor would ordinarily have diagnosed this without a CT scan. The doctor would also have picked up any associated umbilical hernia or supraumbilical hernia, and if these were present, the doctor would have repaired them at the same time. I don't know why she has undergone a CT scan now, but if she actually does have an umbilical hernia and/or a supraumbilical hernia, these should have been picked up before her surgery for ventral hernia. You should ask the doctor why he/she did not detect these before surgery.

Presuming that ventral hernia, which was just repaired, was umbilical or supraumbilical: If she now has an umbilical / supraumbilical hernia, she probably has a recurrence after surgery. Recurrence after surgery used to occur in 10-35% of patients in the past. Now, with the use of a mesh, the recurrence rate is less than 5%.

I don't know why a CT scan has been done after surgery for ventral hernia. Did the doctor notice an umbilical bulge and try to confirm the nature of the bulge?

Referring to your question, "how can this be managed", the answer is that she needs surgery if she really has umbilical / supraumbilical hernias. The timing of the surgery can be discussed, but there is no other treatment.

I hope this helps. This is an unusual situation, and I may be addressing the wrong angle.

A.  The diagnosis of an umbilical hernia, supraumbilical hernia, or of almost any other abdominal wall ventral hernia is "clinical", which means that it does not depend on a CT scan or on any other investigation.

Presuming that ventral hernia, which was just repaired, was infra-umbilical, meaning below the umbilicus: If she had a ventral hernia that needed repair, the doctor would ordinarily have diagnosed this without a CT scan. The doctor would also have picked up any associated umbilical hernia or supraumbilical hernia, and if these were present, the doctor would have repaired them at the same time. I don't know why she has undergone a CT scan now, but if she actually does have an umbilical hernia and/or a supraumbilical hernia, these should have been picked up before her surgery for ventral hernia. You should ask the doctor why he/she did not detect these before surgery.

Presuming that ventral hernia, which was just repaired, was umbilical or supraumbilical: If she now has an umbilical / supraumbilical hernia, she probably has a recurrence after surgery. Recurrence after surgery used to occur in 10-35% of patients in the past. Now, with the use of a mesh, the recurrence rate is less than 5%.

I don't know why a CT scan has been done after surgery for ventral hernia. Did the doctor notice an umbilical bulge and try to confirm the nature of the bulge?

Referring to your question, "how can this be managed", the answer is that she needs surgery if she really has umbilical / supraumbilical hernias. The timing of the surgery can be discussed, but there is no other treatment.

I hope this helps. This is an unusual situation, and I may be addressing the wrong angle.

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