The older methods of operation for the radical cure of large umbilical hernias were so unpromising that few surgeons cared to attack them unless forced to do so by acute conditions. Not only was the prospect of relief uncertain, but there was considerable danger attending the operation itself because of increased intraabdominal tension, as the recognized procedure was to dissect out the recti muscles and transplant them to the median line.
These patients are usually obese with thinned-out recti muscles widely separated, so that when brought in apposition they have but little retentive power, even if the tension which is necessarily put on them is sufficient to maintain them in position.
The hernial opening lies above the attachments of the urachus and remnants of the hypogastric arteries in the umbilical scar. That these three structures exercise some influence is evidenced by the fossa which they normally outline in the peritoneal
MAYO WJ. RADICAL CURE OF UMBILICAL HERNIA.. JAMA. 1907;XLVIII(22):1842-1844. doi:10.1001/jama.1907.25220480020002d