ABSTRACT
The usual constituent of a paraumbilical hernia is Omentum. Small paraumbilical hernias are often mistaken for lipomas on ultrasound scans. A curved infra-umbilical incision is made and the subcutaneous tissues are dissected from the rectus sheath. The hernial sac is identified, and its neck is outlined at the level of the fascia. The sac is opened and the contents are examined and reduced. The superior fold of the fascia is overlapped on top of the inferior fold, in a double-breasted manner, using non-absorbable interrupted mattress sutures. The overlap is then made secure with a continuous suture. Incisional hernias are difficult to repair and often fail. The patient should be optimised preoperatively, and any reversible causes of the initial hernia, such as malnutrition or obesity, should be corrected. The peritoneum and posterior rectus sheath are dissected off the posterior aspect of the rectus muscle laterally.
