Umbilical hernia: when and how

The incidence of umbilical hernias in adults ranges from 10% to 25% in the literature and is increased in females. Some predisposing factors for umbilical hernia development include pregnancy, obesity, ascites and large abdominal tumors leading to increased abdominal pressure. Although tension-free mesh repair is widely-accepted as the gold standard in the repair of ventral hernia, there are some controversies over the best approach especially for small defects in the umbilical region, women of childbearing age and obese patients. The aim of this review is to shed light on how and when to repair umbilical hernias in the face of the most recent publications, as well as to discuss unique situations such as pregnancy, cirrhotic patients and in the emergency setting.