Umbilical Hernia Repair
What is an umbilical hernia?
A hernia is a bulge that has formed when the internal organs of the body push through a weak spot in the abdominal wall. Umbilical (paraumbilical) hernia is the bulge that forms near the navel or belly button, when a part of the intestine, fat or fluid is pushed out through a weakened muscle of the abdomen. Umbilical hernia can be found in both children and adults.
What causes an umbilical hernia?
Umbilical hernia is commonly caused in infants and young children, especially in premature babies. The umbilical cord passes through a small muscular opening in the baby's abdomen during pregnancy. Sometimes, the muscles of the umbilical opening fail to close completely after birth. This leads to a weak spot near the navel, which allows the internal organs of the abdomen to push through it.
People with various health issues that can put pressure on the abdomen, such as being overweight, multiple pregnancies, having ascites (excessive fluid in the belly), are prone to developing an umbilical hernia. Other situations such as lifting heavy objects, straining on the abdominal muscles during constipation or coughing, and having a large prostate gland may also cause umbilical hernia.
What are the signs and symptoms of umbilical hernia?
The main symptom of an umbilical hernia is the presence of a swelling or bulge near the navel, which ranges from 1 to 5 cm in diameter.
The bulge may be noticeable in babies when they cough, cry or strain the abdomen, and may reduce while lying down or staying calm. This hernia is generally not painful in children. However, umbilical hernias in adults may cause pain, discomfort and increase in size over time.
How is an umbilical hernia diagnosed?
To diagnose an umbilical hernia, your doctor will review your symptoms and your medical history.
Physical examination is generally conducted to determine the size and prominence of the umbilical hernia. Your bulge will be examined when you are standing and lying down. Your doctor may try to reduce the bulge by pushing it inside your abdomen, and will ask you to cough to see if there is any change in size of the bulge. Blood tests and imaging tests such as X-rays, MRI scan or CT scan may be ordered to confirm on the diagnosis.
What are the options for umbilical hernia treatment?
In adults, a painful and enlarged bulge is usually treated with surgery. Surgery can prevent further complications of the hernia, which can occur due to strangulation. However, in children, the hernia generally resolves by 18 months. Your doctor may wait for a while before suggesting surgery.
What are the consequences of not treating an umbilical hernia?
Left untreated, umbilical hernias can get trapped and strangulated, thereby cutting off the blood supply to the trapped part. This may cause death of the trapped tissue (gangrene necrosis) and result in severe complications.
Am I a candidate for umbilical hernia repair?
Indications for recommending surgical repair in children include:
- Painful, trapped or strangulated hernia
- Hernia fails to close by 5 or 6 years
- Large hole near the navel (greater than 1 inch in diameter)
Hernia repair in adults is recommended only if the hernia is big, painful and has the risk of getting trapped and strangulated.
How do I prepare for umbilical hernia repair?
Before umbilical hernia repair, your physical and medical history will be reviewed to determine your suitability for surgery. You will be instructed to fast for 6 to 8 hours before your procedure. Inform your surgeon about the medication that you take on a regular basis. You will be advised on the ones you can take and those you need to avoid during surgery.
How is umbilical hernia repair performed?
Your surgeon may perform either an open surgery or a keyhole surgery (laparoscopy) to repair the umbilical hernia. Laparoscopy may be recommended if the hernia has reappeared after a prior surgery. Surgery can be performed under general or local anaesthesia.
Your surgeon will make a single incision of 2 to 3 cm below the navel and push the protruded part into your abdomen. The weakened spot of the abdominal wall will then be stitched with sutures. In case of a large hernia, your surgeon may place a mesh patch to strengthen the weak abdominal wall. The skin will be sutured with dissolvable stitches and a dressing applied to the wounded area.
Keyhole surgery (laparoscopy)
Your surgeon will make two to three small incisions away from the bulge and insert a laparoscope (a fibre-optic tube with a light source and camera attached to it) and other special instruments through the incisions. The bulge will be pushed into the abdominal cavity, and the abdominal wall will either be stitched or a mesh placed to support the weak part of your abdominal wall.
What can I expect after umbilical hernia repair?
An umbilical hernia repair is usually done as a day case admission so you will be able to go home on the same day of the surgery. Following the surgery, you will be monitored and prescribed pain medication to keep you comfortable. Your doctor will prescribe pain medication to keep you comfortable at home in the week following surgery.
What are the benefits of umbilical hernia repair?
Surgery is the only means to repair an umbilical hernia. Further, laparoscopic umbilical hernia surgery has the below benefits when compared to an open approach.
- Shorter hospital stay
- Faster recovery
- Smaller scars
- Less postoperative pain
- Less wound infection
- Faster return to regular diet
Describe the stages of recovery and care.
You may experience tenderness, swelling and bruising around the wound. It should take you or your child 2-4 weeks to resume normal activities. You will be able to perform light activities 1 or 2 weeks after procedure, but you should avoid lifting heavy objects and strenuous activities for 4-6 weeks. You are encouraged to engage in walking and other gentle exercises to aid in the healing process. Ask your surgeon about driving.
Your wound will be covered with a waterproof plastic dressing which allows you to shower as normal. This dressing and any stitches are removed at your follow up appointment in 7 to 10 days. It will be more comfortable for you to wear loose clothing. Drink plenty of water and eat a diet rich in fibre to prevent constipation.
What are the outcomes of umbilical hernia repair?
Umbilical hernia repair is effective in treating the hernia; however, there are chances that it can recur. As with all surgeries, umbilical hernia repair may be associated with certain complications such as infection, bleeding, blood clots and injury to the intestine.
How long will I be off work/school?
Your child can return to school after about 1 week and can start sports in about 2 weeks. You will be able to resume your work after 1-2 weeks unless your work involves strenuous manual labour.
What is the cost of the procedure?
We will provide you with a full explanation of the costs of the operation to assist you in your decision to proceed. The costs will vary depending on your level of private health insurance.
Ongoing research on umbilical hernia include:
- Kim LT. Complexity of the "Simple" Umbilical Hernia Repair. JAMA Surg. 2017 Jan 25. doi: 10.1001/jamasurg.2016.5053. [Epub ahead of print]
- Shankar DA, Itani KM, O'Brien WJ, Sanchez VM. Factors Associated with Long-term Outcomes of Umbilical Hernia Repair. JAMA Surg. 2017 Jan 25. doi: 10.1001/jamasurg.2016.5052. [Epub ahead of print]