Purpose:

To describe a novel, simplified surgical technique for the correction of umbilical hernias in conjunction with abdominoplasty.

Background:

Abdominoplasty is one of the most common aesthetic procedures performed in the United States. One of the primary indications for the procedure is skin and fascial laxity, often found in multiparous women. Abdominal wall hernias are often diagnosed on clinical examination and/or encountered intra-operatively during an abdominoplasty. Traditional surgical techniques for abdominoplasty and umbilical hernia repair, when performed simultaneously, can potentially compromise the vascular supply to the umbilicus, resulting in necrosis. Our novel, simplified surgical technique avoids any fascial incisions immediately adjacent to the umbilicus, thereby maintaining maximal blood supply to the umbilical stalk.

Operative Technique:

The abdominal flap is elevated and the umbilicus is dissected from the anterior abdominal wall flap while maintaining blood supply from its underlying fascial attachment. A 3-4 cm midline longitudinal laparotomy incision is made through the primarily avascular linea alba inferior to the umbilical stalk. The fascial defect is identified and the hernia reduced from the undersurface of the umbilicus either in the preperitoneal or intra-peritoneal space. The hernia is then repaired with interrupted monofilament sutures, and the midline laparotomy fascial incision closed with running suture. Plication of the rectus fascia is then performed.

Results:

17 patients, over a 6 year period, have undergone umbilical hernia repair with simultaneous abdominoplasty with the aforementioned surgical technique. None have had a recurrence of their hernia or umbilical necrosis and the aesthetics of the umbilicus have been improved.

Conclusions:

The novel operative technique described above provides a safe and simplified method of correcting umbilical hernias in conjunction with abdominoplasty and in our experience avoids the risk of umbilical necrosis and improves overall aesthetics.