2481 2482 ## Summary box 64.13 2483 2484 2485

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

2486 2487 2488 ## Umbilical hernia 2489 2490 The umbilical defect is present at birth but closes as the stump 2491 of the umbilical cord heals, usually within a week of birth. 2492 This process may be delayed, leading to the development of 2493 herniation in the neonatal period. The umbilical ring may also 2494 stretch and reopen in adult life. 2495 2496 2497 2498 2499 ## Umbilical hernia in children 2500 2501 This common condition occurs in up to 10% of infants, with 2502 a higher incidence in premature babies. The hernia appears 2503 within a few weeks of birth and is often symptomless, but 2504 increases in size on crying and assumes a classic conical shape. 2505 Sexes are equally affected but the incidence in black infants 2506 is up to eight times higher than in white. Obstruction and/or 2507 strangulation is extremely uncommon below the age of 3 years. 2508 2509 2510 ## Treatment 2511 2512 Conservative treatment is indicated under the age of 2 years 2513 when the hernia is symptomless. Parental reassurance is all that 2514 is necessary as 95% will resolve spontaneously. If the hernia 2515 persists beyond the age of 2 years surgical repair is indicated. 2516 2517 2518 ## Surgery 2519 2520 A small, curved incision is made immediately below the umbi- 2521 licus. The neck of the sac is defined, opened and any contents 2522 are returned to the peritoneal cavity. The sac is closed and 2523 redundant sac excised. The defect in the linea alba is closed 2524 with interrupted sutures of slowly absorbable material. 2525 2526 2527 ## Summary box 64.14 2528 2529 2530 ## Umbilical hernia in children 2531 2532 Common in infants and most resolve spontaneously 2533 2534 • Rarely strangulate 2535 2536 2537 ## Umbilical hernia in adults 2538 2539 Conditions that cause stretching and thinning of the midline 2540 raphe (linea alba), such as pregnancy, obesity and liver disease 2541 with cirrhosis and ascites, predispose to reopening of the 2542 umbilical defect. In adults, the defect can be not only through 2543 the umbilicus but also in the median raphe (linea alba) imme- 2544 diately adjacent to (most often above) the true umbilicus. The 2545 latter are commonly called ‘paraumbilical’ hernias; however, 2546 under current guidelines, any hernia in the immediate vicinity 2547 of the umbilicus can now be called ‘umbilical’. Small umbilical 2548 hernias often contain extraperitoneal fat or omentum. Larger 2549 hernias can contain small or large bowel. Because the hernia 2550 neck is relatively narrow in relation to the size of the sac, they 2551 [... Output truncated due to length. 4858 tokens/16431 characters removed ...]