The results of operations for the radical cure of umbilical herniæin adults have; heretofore, not been encouraging. These patients are usually obese, with attenuated abdominal muscles, and the thin, rigid character of the ring does not offer mechanical conditions advantageous to lasting union.
The principles of closure have been the same as after an ordinary abdominal section, the object being to split the fascia at the ring margins laterally, until the recti muscles are reached, and then, by a series of buried sutures, to reconstruct the abdominal wall in layers. The defect in this method is the natural separation of the recti muscles at the level of the umbilicus. Below this point the muscular structures are practically in contact, but above there is from one-fourth to three-fourths of an inch separation. To bring the recti together in this locality amounts to a muscle transplantation. In a small hernia this muscular