Hernia repairs are common. Larger hernias often require the repositioning of the rectus abdominus muscles to place the muscles back into anatomic position. When the rectus muscles are relocated this can often prevent the use of mesh to repair the hernia. In some cases mesh is necessary in addition to repositioning of the abdominal musculature.
In patients with previous abdominal surgery close to the umbilicus, it is often necessary to remove the umbilicus at the time of surgery. This is secondary to the resulting blood supply of the umbilical stalk.
A new umbilicus can be recreated at the time of reconstruction or in a second stage. I prefer to do this in a second stage when the wounds have healed and the skin is devoid of swelling or edema.