Umbilical hernias are ideally repaired with a pledgeted suture. The pledgets prevent the suture from cutting through the fascia. The medline abdominal fascia (linea alba) is very strong but is fragile and tears very easily, kind of like paper. Pledgets distribute the shearing stress of a suture and prevent tearing or cutting through the fascia.
Cardio-vascular surgeons use pledgeted suture to close cuts made in the aorta. Pledgeted suture hernia repairs work well for all, relatively small, midline, abdominal hernia repairs. They are not appropriate for other types of abdominal hernias.
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