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Umbilical hernia repair

Definition

Umbilical hernia repair is surgery to repair an umbilical hernia. An umbilical hernia is a sac (pouch) formed from the inner lining of your belly (abdominal cavity) that pushes through a hole in the abdominal wall at the belly button.

Description

You will probably receive general anesthesia (asleep and pain-free) for this surgery. If your hernia is small, you may receive spinal or epidural block anesthesia and medicine to relax you. You will be awake but pain-free.

Your surgeon will make a surgical cut under your belly button.

• Your surgeon will find your hernia and separate it from the tissues around it. Then your surgeon will gently push the contents of the intestine back into the abdomen. The surgeon will only cut the intestines if they have been damaged.
• Strong stitches will be used to repair the hole or weak spot caused by the umbilical hernia.
• Your surgeon may also lay a piece of mesh over the weak area (usually not in children) to make it stronger.

Umbilical hernia can also be repaired using a laparoscope, a thin, lighted tube that lets the doctor see inside your belly. The laparoscope will be inserted through one of the cuts and instruments will be inserted through the other cuts.

If your child is having this surgery, the surgeon will discuss the type of anesthesia your child will receive. The surgeon will also describe how the surgery will be done.

Why the Procedure Is Performed

Children:

Umbilical hernias are fairly common. A hernia at birth will push the belly button out. It shows more when a baby cries because the pressure from crying makes the hernia bulge out more.

In infants, the problem is not usually treated with surgery. Most of the time, the umbilical hernia shrinks and closes on its own by the time a child is 3 or 4 years old.

Umbilical hernia repair may be needed in children for these reasons:

• The hernia is painful and stuck in the bulging position.
• Blood supply is affected.
• The hernia has not closed by age 5 or 6.
• The defect is very large or unacceptable to parents because of how it makes their child look. Even in these cases, the doctor may suggest waiting until your child is 5 or 6 to see if the hernia closes on its own.

Adults:

Umbilical hernias are fairly common in adults. They are seen more in overweight people and in women, especially after pregnancy. They tend to get bigger over time.

Smaller hernias with no symptoms sometimes can be watched. Surgery may pose greater risks for patients with serious medical problems.

Without surgery, there is a risk that some fat or part of the intestine will get stuck (incarcerated) in the hernia and become impossible to push back in. This is usually painful. If the blood supply to this area is cut off (strangulation), urgent surgery is needed. You may experience nausea or vomiting, and the bulging area may turn blue or a darker color.

To avoid this problem, surgeons often recommend repairing the umbilical hernia in adults. Surgery is also used for hernias that are getting larger or are painful. Surgery secures the weakened abdominal wall tissue (fascia) and closes any holes.

Get medical care right away if you have a hernia that does not get smaller when you are lying down or that you cannot push back in.

Risks

The risks of surgery for umbilical hernia are usually very low, unless the patient also has other serious medical problems.

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems, such as pneumonia
• Heart problems

Risks for any surgery are:

• Bleeding
• Infection

A specific risk of umbilical hernia surgery is injury to the bowel (large intestine). This is rare.

Before the Procedure

Your surgeon or anesthesia doctor will see you and give you instructions for you or your child.

An anesthesiologist will discuss your (or your child's) medical history to determine the right amount and type of anesthesia to use. You or your child may be asked to stop eating and drinking 6 hours before surgery. Make sure you tell your doctor or nurse about any medications, allergies, or history of bleeding problems.

Several days before surgery, you may be asked to stop taking:

• Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, Motrin, Advil, or Aleve
• Other blood thinning medications
• Certain vitamins and supplements

After the Procedure

Most umbilical hernia repairs are done on an outpatient basis, which means that you will likely go home on the same day. Some repairs may require a short hospital stay if the hernia is very large.

After surgery, your doctor and nurse will monitor your vital signs (pulse, blood pressure, and breathing). You will stay in the recovery area until you are stable. Your doctor will prescribe pain medicine if you need it.

Your doctor or nurse will show you how to care for your or your child’s incision at home. You or your child should be able to do all of your normal activities in 2 - 4 weeks.

Outlook (Prognosis)

There is always a chance that the hernia can come back. However, for healthy patients, the risk of it coming back is very low.

References

Malangoni MA, Rosen MJ. Hernias. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 46.

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