Umbilical hernia repair Health Article

Definition

Umbilical hernia repair is surgery to correct an umbilical hernia, a sac of abdominal tissue that sticks through the belly button.

Description

The surgery is often done under general anesthesia (asleep, pain-free), but small hernias may be repaired while the person is under local anesthesia (awake but pain-free). A surgical cut is made under the belly button. The surgeon identifies the hernia sac, separates it from the surrounding tissues, and pushes it back inside the abdominal cavity.

If the hernia defect is very small, it may be closed with strong non-absorbable sutures (stitches). If the hernia defect is larger, it should be closed with a piece of mesh.

Indications

Children:

Umbilical hernias are fairly common. Such a hernia is obvious at birth, as it pushes the belly button outward. This is more obvious when the infant cries, becauses increased pressure results in more noticable bulging.

In infants, the defect is not usually treated surgically. In most cases, by age 3 the umbilical hernia shrinks and closes without treatment.

Umbilical hernia repair may be necessary for children for the following reasons:

• The herniated tissue is stuck in the protruding position, or if blood supply is affected
• The defect has not closed by age 3 or 4
• The defect is very large or unacceptable to parents for cosmetic reasons

Adults:

Umbilical or para-umbilical hernias are relatively common in adults. They are more common in overweight people and in women, especially after pregnancy. Most surgeons recommend they be surgically repaired, as they tend to get bigger over time.

Without surgery, there is a risk that some abdominal contents, typically a bit of fat or intestine, will get stuck (incarcerated) in the hernia defect and become impossible to push back in, which is typically painful. If the blood supply is compromised (strangulation), urgent surgery is needed.

Incarcerated abdominal tissue may cause nausea, vomiting, and abdominal distension.

Any patient with a hernia that cannot be reduced, or pushed back in, while lying down and relaxed should seek urgent medical attention.

Risks

Risks for any anesthesia include the following:

• Reactions to medications
• Breathing problems, pneumonia
• Heart problems

• Bleeding
• Infection

Risks specific to umbilical hernia surgery include injury to bowel, which is rare.

Expectations after surgery

Expect successful repair of the hernia. The long-term prognosis is excellent. Very rarely the hernia will recur. Recurrence is more common if a larger hernia (more than 3 cm) is repaired without a mesh.

Convalescence

Most umbilical hernia repairs are done on an outpatient basis, but some may require a short hospital stay if the hernia is very large.

After surgery, the health care team will monitor the patient's vital signs. The patient will stay in the recovery area until stable. Pain medication is prescribed as needed.

Patients, or parents if the patient is a child, are taught to care for the surgical cut at home. Full activity can be resumed in 2-4 weeks.