Treatment
If the defect is very small, I repair the hernia by reducing the hernia and stitching the linea alba with a permanent stitch. If the defect is big, I place a plastic mesh behind the abdominal wall to cover the gap (as shown below). The mesh is held in place with permanent stitches. The mesh stays forever. Its main function is to cause scarring - this is the real repair and can take 4-6 weeks to develop fully. The skin is closed with a dissolving stitch (buried under the skin). The wound will often have a special glue dressing (Dermabond) - this is water resistant and means you can have a shower the following day. It is also see-through allowing wound inspection.
The following video shows the operation to repair a paraumbilical hernia. The sac is isolated and reduced and then a space is created behind the abdominal wall for mesh insertion. I use a prolene hernia system. The on-lay part is trimmed and the collar sutured into the defect in the abdominal wall. The fat and skin are then closed over the mesh.
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