2466 2466 thought to relate more to misdiagnosis of the hernia (ingu- 2467 2467 nal versus femoral) than true recurrence. The laparoscopic 2468 2468 approach allows good visualisation of all the hernia orifices, 2469 2469 removing any diagnostic uncertainty. 2470 2470 2471 2471 2472 2472 ## VENTRAL HERNIA 2473 2473 2474 2474 This term refers to hernias of the anterior abdominal wall. 2475 2475 Inguinal and femoral hernias are not included, however lumbar 2476 2476 hernia is included despite being dorsolateral. The European 2477 2477 Hernia Society classification (2009) distinguished primary 2478 2478 ventral from incisional hernia but did not include parastomal 2479 2479 hernia, which is included in this section. 2480 2480 2481 2481 2482 2482 ## Summary box 64.13 2483 2483 2484 2484 2485 2485

Primary ventral hernias	'Secondary' ventral hernias
Umbilical Epigastric Spigelian Lumbar Traumatic	Incisional Parastomal

2486 2486 2487 2487 2488 2488 ## Umbilical hernia 2489 2489 2490 2490 The umbilical defect is present at birth but closes as the stump 2491 2491 of the umbilical cord heals, usually within a week of birth. 2492 2492 This process may be delayed, leading to the development of 2493 2493 herniation in the neonatal period. The umbilical ring may also 2494 2494 stretch and reopen in adult life. 2495 2495 2496 2496 2497 2497 2498 2498 2499 2499 ## Umbilical hernia in children 2500 2500 2501 2501 This common condition occurs in up to 10% of infants, with 2502 2502 a higher incidence in premature babies. The hernia appears 2503 2503 within a few weeks of birth and is often symptomless, but 2504 2504 increases in size on crying and assumes a classic conical shape. 2505 2505 Sexes are equally affected but the incidence in black infants 2506 2506 is up to eight times higher than in white. Obstruction and/or 2507 2507 strangulation is extremely uncommon below the age of 3 years. 2508 2508 2509 2509 2510 2510 ## Treatment 2511 2511 2512 2512 Conservative treatment is indicated under the age of 2 years 2513 2513 when the hernia is symptomless. Parental reassurance is all that 2514 2514 is necessary as 95% will resolve spontaneously. If the hernia 2515 2515 persists beyond the age of 2 years surgical repair is indicated. 2516 2516 2517 2517 2518 2518 ## Surgery 2519 2519 2520 2520 A small, curved incision is made immediately below the umbi- 2521 2521 licus. The neck of the sac is defined, opened and any contents 2522 2522 are returned to the peritoneal cavity. The sac is closed and 2523 2523 redundant sac excised. [... Output truncated due to length. 705 tokens/2081 characters removed ...]