. The midabdomen was prepped and draped in sterile fashion, and local anesthesia was obtained by infiltration of half percent Marcaine and 1% lidocaine mix into the skin and subcutaneous tissue. A small curved incision was made just above the umbilical dimple and carried in the subcutaneous tissue this dissection was carried down to the level of the fascia and no obvious hernia mass is encountered at that point. The skin of the umbilical defect was mobilized and there was a tiny fascial defect just below the skin margin where a small nodule of intraperitoneal fat protruded in the midline. This fascial defect was circumferentially dissected it was quite tiny, less than a centimeter across. No other abnormalities were noted, so this defect was closed with a single figure-of-eight suture of heavy nylon suture. The umbilical skin is tacked to the suture line with a small absorbable suture, and subcutaneous tissue and skin are then closed with fine absorbable suture.