Bardají Bofill Manel

They are those that protrude through the umbilical ring not obliterated in embryonic life, which would be congenital hernias, or through an open umbilical ring after birth, which would be the hernias acquired from the child and the adult.

The annulus fibrosus that remains after the fall of the umbilical cord is covered by a fascia that goes from side to side, Richet's fascia, to this ring they reach from below: the fibrous remains of the umbilical veins and the fibrous cord of the urachus, reaching from above the cord of the umbilical vein.

Predisposing causes

Obesity, pregnancies, repeated births, sudden weight loss in the obese, intra-abdominal tumors, efforts in patients with constipation, prostaterates and coughers, in addition the aponeuroses of the broad muscles of the abdomen make traction on the pods of the recti separating them. In children the predisposing causes can be, cough, constipation, crying, sneezing, flatulence, trauma.

Congenital umbilical hernias, would be the omphalocele or amniotic hernia, which must be treated as an emergency surgical condition, it is not a strangulated hernia, nor a hernia, from the embryological point of view it is a lack of coalescence in the abdominal wall, it is the protrusion of viscera that have not been introduced into the abdomen through the base of the umbilical cord.

The hernial sac consists of the amniotic sac and the peritoneum, it can sometimes be very small and be confused by a normal umbilical cord. When they are large there is a great disproportion between the abdominal cavity and the viscera that protrude, you have to try to close the sac and cover it with skin.

By definition, a hernia is the protrusion of viscera contained in the abdomino-pelvic cavity, through areas of weakness of the abdominal or perineal wall congenitalitously pre-constituted, or through the fascial and muscular layer intended to contain them.

The important features of a hernia are the hernial hole and sac. The hole is the defect in the innermost aponeurotic layer of the abdomen and the sac an evagination of the peritoneum.

The neck of the hernial sac corresponds to the hole. The hernia is external if the sac exits completely through the abdominal wall and internal if it is located within the visceral cavity.

The hernia is reducible when it is possible to return to the abdomen the viscera that has come out and irreducible if this is not feasible. A strangulated hernia is one in which the vascularization of the viscera that has come out is compromised; It occurs in those with small holes and large sacs.

Incarcerated hernia is irreducible, but not necessarily strangulated. A Richter hernia is one in which the sac contains only one side of the wall of the intestine (always antimesenteric).

Different types:

• Inguinal
• Crurales
• Umbilical
• Epigastric
• Obturatrices
• White line or epigastric
• Spieghel
• Sciaticas the sciatics
• Perineales
• Upper and lower lumbar
• Diaphragmátics
• Paraostomals
• Incisional hernia or eventration: also called incisional or laparotomic hernia. It is defined as the exit of the abdominal continent by default of the non-anatomical wall but produced by a previous surgical intervention, the abdominal contents cross the muscle-aponeurotic wall and is under the skin. Its two main causes are obesity and infection. The treatment will always require prosthesis - mesh either by laparoscopy technique or by conventional open surgery.