Smiley Incision for Repair of Para Umbilical Hernia

Smiley Incision for Open Repair of Para Umbilical Hernia

   A Para Umbilical Hernia is herniation of the intra abdominal contents like omentum or intestine through a defect in the linea alba in the region of the umbilicus.

  Aetiological factors include conditions with  increased intra abdominal pressure like chronic cough, constipation, benign prostatic hypertrophy or an intra abdominal tumour. A weak anterior abdominal wall due to repeated pregnancy is another cause. 

   The complications include irreducibility, intestinal obstruction and strangulation ( arrest of blood supply ) of the contents.  The patient can also experience dragging pain due to the pull on to the mesentery. Hence a surgical correction is indicated.

  One common surgical procedure is the open repair of the para umbilical hernia, done under epidural or spinal anesthesia. The incision is a curved infra umbilical one called  the 'smiley incision.' The sac is dissected out and content is visualized. Beware of the bowel loop especially the transverse colon which can be a content of the sac.

    If the size of the defect is less than 2 centimeters a primary repair using Number one polypropylene and reinforcing darning ( figure of eight sutures ) is done. If the size of the defect is larger a polypropylene mesh is placed for the repair.

   If the mesh is placed over the linea alba, it is called 'On Lay Mesh Repair.'  If the mesh is placed in the  pre peritoneal plane it is called 'In Lay Mesh Repair.'