What tests or imaging are required prior to umbilical hernia surgery?

Preoperative Testing for Umbilical Hernia Surgery

For routine umbilical hernia repair, minimal preoperative testing is required, typically limited to basic laboratory tests including complete blood count, basic metabolic panel, and liver function tests, with additional testing only for patients with specific risk factors.

Standard Preoperative Testing

Basic Laboratory Tests

• Complete blood count (CBC) - to assess for anemia or infection 1
• Basic metabolic panel - to evaluate electrolytes and renal function 1
• Liver function tests - especially important for patients with suspected liver disease 1

Imaging

• No routine imaging is required for uncomplicated umbilical hernias 1
• Ultrasound guidance may be considered during evaluation if ascites is present 1

Risk-Based Additional Testing

For Patients with Liver Disease/Cirrhosis

• More comprehensive laboratory assessment:
  • Serum albumin - to assess nutritional status and liver synthetic function 1
  • Coagulation studies (PT/INR) - despite guideline recommendations against routine testing, these are often obtained in cirrhotic patients 1
  • C-reactive protein (CRP) and procalcitonin - helpful for assessing inflammatory status 1
  • Serum lactate levels - to evaluate tissue perfusion 1

For Patients with Cardiovascular Risk Factors

• Electrocardiography (ECG) - recommended for patients:
  • Undergoing intermediate-risk surgery with additional risk factors
  • With known cardiovascular disease
  • With symptoms suggestive of cardiovascular disease 1

For Patients with Pulmonary Risk Factors

• Chest radiography - only if results would change perioperative management 1
• Not recommended routinely for all patients 1

Special Considerations

For Patients with Ascites

• Ultrasound of the abdomen - to assess the extent of ascites and hernia characteristics 1
• Ascites control is crucial before elective herniorrhaphy 1, 2
• Consider multidisciplinary approach involving hepatologists for patients with cirrhosis 1

For Patients with Extensive Collateral Veins

• Duplex sonography vein mapping - to identify safe areas for trocar placement in laparoscopic repair 3

Common Pitfalls to Avoid

1. Unnecessary testing: Routine preoperative testing in healthy patients undergoing low-risk procedures increases costs without improving outcomes 1

2. Inadequate evaluation of liver function: Patients with umbilical hernias often have underlying liver disease that requires thorough evaluation before surgery 1, 4

3. Overlooking nutritional status: Poor nutrition increases recurrence risk, so nutritional assessment should be performed 1, 2

4. Failure to optimize ascites control: Uncontrolled ascites significantly increases surgical complications and recurrence rates 1, 2

5. Ignoring hernia size: Hernias >2 cm have higher recurrence rates and may require mesh repair, which should be considered in preoperative planning 5

By following these evidence-based guidelines for preoperative testing, surgeons can ensure appropriate patient preparation while avoiding unnecessary tests that increase costs without improving outcomes.