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Q1: Paediatric vs Adult (2 min)
"How does management differ between paediatric and adult umbilical hernia?"
- Paediatric: 95% close by age 5; observe until 4-5; repair if persists or incarcerates
- Adult: never close spontaneously; always surgical repair if symptomatic
- Mesh for defects over 1 cm in adults; primary closure acceptable in children
Q2: Surgical Approach (3 min)
"What are the surgical options for adult umbilical hernia?"
- Under 1 cm: primary suture repair
- 1-4 cm: open mesh repair (sublay preferred over onlay)
- Over 4 cm: laparoscopic IPOM
- Over 10 cm: component separation
- Mayo vest-over-pants is historical; high recurrence
Q3: Richter's Hernia (3 min)
"What is a Richter's hernia?"
- Only the anti-mesenteric border of bowel in the hernia sac
- Can strangulate WITHOUT obstructive symptoms (no vomiting/distension)
- High risk of perforation
- Common in small defects: umbilical, epigastric, femoral
- Emergency surgery: resection of gangrenous bowel + repair
Q4: Cirrhotic Umbilical Hernia (2 min)
"How do you manage umbilical hernia in cirrhosis?"
- Optimise cirrhosis first: diuretics, albumin, control ascites
- Elective repair with mesh once Child-Pugh A-B
- Emergency only for strangulation/perforation (very high mortality)
- Child-Pugh C: high morbidity/mortality — multidisciplinary decision