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Summary

Umbilical hernia is a small lump that is visible around the belly button (navel) in some individuals. It develops when the intestine or fatty tissue protrudes through an opening in the inner muscle layer of the abdomen. Though the hernia itself may not be dangerous, (some people delay surgery till they show symptoms of distress) but it can cause serious complications if the intestine gets strangulated inside the hernia and the blood supply to that piece stops. Surgery is the only way to fix umbilical hernia. The surgery requires you to have an empty stomach for 6 hours before the surgery. It involves the administration of anaesthesia (medicine that helps you to sleep) and can be performed by any of the following two methods: open repair or laparoscopic umbilical hernia surgery. This surgery mostly allows for same-day discharge. You or your child should be able to return to work or school in a week or two.

Read more: Hernia types and causes

  1. What is umbilical hernia surgery?
  2. Why is an umbilical hernia surgery recommended?
  3. Who can and cannot get this umbilical hernia surgery?
  4. What preparations are needed before the umbilical hernia surgery?
  5. How is the umbilical hernia surgery done?
  6. How to care for yourself after the umbilical hernia surgery?
  7. What are the possible complications/risks of umbilical hernia surgery?
  8. When to follow up with your doctor?

This surgery is performed to repair an umbilical hernia.

An umbilical hernia is a sac (pouch) made from the inner lining of the abdomen which bulges out through an opening (hole) in the inner muscle layer of the abdominal wall near the belly button (navel). It is commonly seen in infants and young children, especially in preterm babies, as a painless lump near the navel.

The umbilical cord runs from an opening in the baby’s abdomen to the placenta of the mother to provide nutrition to the baby inside the womb. The opening usually closes immediately after birth; however, in some cases, it does not close completely. In most such cases, an umbilical hernia disappears before the child completes 1 year of age. Umbilical hernia surgery is recommended if the hernia is either large or if it hasn’t disappeared before the child turns 3 or 4 years old.

An umbilical hernia may also develop in adults due to conditions that increase the pressure in the abdomen. Common causes of umbilical hernia in adults include:

Umbilical hernia can result in a serious medical condition called a strangulated umbilical hernia (a part of the intestine gets trapped in the abdominal opening and does not get enough blood supply). The risk of complications is low in children as compared to that in adults.

Doctors recommend this surgery in children if the hernia:

  • Is getting larger
  • Cannot be pushed back inside the abdomen and is painful
  • Is present beyond 3 years of age
  • Affects blood supply to intestines
  • Is very large or the way it makes the child look is unacceptable to the parents (in this case, the doctor would advise waiting till 3-4 years of age to see if the hernia closes on its own).

Umbilical hernia surgery is recommended in adults if the hernia is increasing in size or is painful.

In both children and adults, if symptoms of strangulated umbilical hernia such as the following are seen, immediate surgery will be advised:

  • Constipation
  • A round, full abdomen
  • Vomiting
  • Purple, red, dark, or discoloured bulge
  • Pain or tenderness in the abdomen Read more: Stomach pain causes
  • Fever

Doctors may recommend this surgery in people with the following conditions:

  • Strangulated umbilical hernia
  • Hernia in children that has not closed till 3 to 4 years of age
  • Children below 2 years of age with a large umbilical hernia
  • Hernia in adults that is painful or increasing in size

Umbilical hernia surgery is not advisable in people with uncontrolled ascites (abnormal accumulation of fluids in the abdomen).

Tell your doctor about all the medicines that you are taking or if you have any allergies or bleeding problems (reduced ability of the blood to clot) in the past.

A few days before the surgery, your doctor may ask you to stop taking medicines such as nonsteroidal anti-inflammatory drugs (e.g., diclofenac and ibuprofen), blood-thinning medicines (e.g., warfarin, rivaroxaban, apixaban, dabigatran, and edoxaban), and certain supplements and vitamins.

You may have to get blood and urine tests and X-ray, MRI, ultrasound, or CT scan of the abdomen to examine the intestine.

On the day of the surgery, you may have to fast (avoid both eating and drinking) for a minimum of 6 hours before the operation. You can take your normal medicines before the surgery with a small quantity of water. You will require someone to accompany or drive you home after the surgery.

After you arrive at the hospital, you will be asked to wear a hospital gown. An intravenous catheter will be inserted into a vein on the back of your hand or your arm to give you fluids and medicines. Before the surgery, you will be given general anaesthesia to help you fall asleep during the surgery. The anaesthesia will be either inhaled as a gas or injected into a vein in the back of your hand in the operating room. The risk of complications from general anaesthesia increases if you have heart, lung, or kidney diseases; are allergic to medicines or smoke or abuse alcohol or medicines.

In individuals who are not eligible for general anaesthesia and have a small hernia, local anaesthesia (only the part that will be operated on is numbed, and you are awake) can be administered.

After administration of anaesthesia, the surgery can be performed by one of two methods, open hernia repair surgery or laparoscopic hernia repair surgery.

Open hernia repair surgery: This method involves the following:

  • The surgeon will make an incision (cut) below your belly button. 
  • He/she will identify the hernia and gently push the protruding intestine back into your abdomen.
  • The hernia opening will then be repaired with stitches.
  • In the case of umbilical hernia in an adult, the surgeon may place a mesh (material made of thread) in the abdomen to strengthen the area.

Laparoscopic hernia repair surgery: This method involves the following:

  • The surgeon will make small cuts (usually three) in your abdomen.
  • A laparoscope will be inserted into one of the cuts. A laparoscope is a tiny telescope-like instrument with a video camera that allows the surgeon to look at the organs inside your abdomen on a television screen.
  • Next, your abdomen will be filled with carbon dioxide to create space for a better view of your abdominal organs. 
  • The surgeon will cut the inner lining of your abdomen to expose the weakened area.
  • He/she will then identify the hernia sac that contains the bulging intestine and push back the hernia inside your abdomen. If needed, a mesh will be placed in your abdomen to cover the abdominal wall and to strengthen the area.
  • After surgery, the small cuts will be closed with surgical tape or stitches.

The laparoscopic method has the following advantages over the open method:

  • It requires tiny cuts 
  • Less pain is experienced after surgery
  • Shorter recovery period

After the surgery, the doctor will monitor your pulse, blood pressure, and breathing. You will be allowed to stay in the recovery room until you become stable.

In most cases, you will be discharged on the same day of the surgery. However, surgery of a large hernia may sometimes require a short hospital stay.

If the surgery was carried out under general anaesthesia (the medicine may affect your reasoning and coordination), then you should avoid operating machinery and drinking alcohol for at least 48 hours after the surgery.

Your doctor may advise you to take painkillers to get relief from pain. Ibuprofen and paracetamol (painkillers) may be given to children. Children under 16 years of age are advised against the use of aspirin.

You can expect the following at home after this surgery:

  • Tenderness and bruising around the wound that normally subsides within a week.
  • Swelling around the wound, which may persist for several weeks.

The following care can be taken on a daily basis after your discharge from the hospital:

  • Change the dressing on your wound as per your surgeon’s instructions.
  • Do not bathe in a bathtub until your stitches/staples have been removed.
  • If you get constipation, you may feel pain around the wound from exerting pressure on the toilet. Hence, try and avoid constipation by drinking a lot of fluids and eating sufficient fruits, vegetables, and fibre-rich foods like wholemeal bread and brown rice.
  • Wear loose clothes to prevent any discomfort.
  • You would mostly be able to start light activities within 1 or 2 weeks after surgery. 
  • Walking and other light exercises can help in wound healing.
  • Do not indulge in heavy activities like weight lifting for at least 4 to 6 weeks.
  • If your child has had the surgery, avoid sending him/her to school for at least a week to allow them time to recover after the surgery.
  • Your child should avoid playing sports for at least 2 weeks after getting back to school. Sports that require physical contact should be avoided for 6 to 8 weeks.
  • Adults who had the surgery can return to office in 1 to 2 weeks, while adults whose work requires manual labour may need more time off for the recovery.
  • You will require 1 to 2 weeks after surgery to make an emergency stop while driving without feeling any pain or discomfort.

When to see the doctor?

Inform your surgeon if you or your child develops any of the following symptoms after surgery:

  • Persistent fever (over 38oC)
  • Chills
  • Bleeding
  • Increased redness around the surgical site
  • Pain or increased swelling in the abdomen
  • Pain that doesn’t subside after taking medicines
  • Stomach cramping
  • Persistent nausea and vomiting
  • Persistent shortness of breath or coughing
  • Difficulty urinating
  • Increased drainage or odour from the surgical site
  • No passing of stools for 3 days

The complications associated with this surgery are seen in less than 10% of people and include:

  • Infection of the wound, resulting in redness, pain, swelling or yellow discharge from the wound
  • Rupture of the wound
  • Change in appearance of the belly button
  • Bleeding
  • The hernia may reappear
  • Injury to the large or small intestine (rare)

Your doctor may tell you when to come for a follow-up before you are discharged from the hospital.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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References

  1. Carlo WA, Ambalavanan N. The umbilicus. In: Kliegman RM, Stanton BF, St. Geme JF, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 105.
  2. Blair LJ, Kercher KW. Umbilical hernia repair. In: Rosen MJ, ed. Atlas of Abdominal Wall Reconstruction. 2nd ed. Philadelphia, PA: Elsevier; 2017:chap 20.
  3. Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 14, 44.
  4. American College of Surgeons [Internet]. Illinois. US; https://www.facs.org/~/media/files/education/patient%20ed/adultumbilical.ashx
  5. National Health Service [internet]. UK; Umbilical hernia repair
  6. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Umbilical Hernia
  7. MedlinePlus Medical Encyclopedia [Internet]. US National Library of Medicine. Bethesda. Maryland. USA; Umbilical hernia repair - series—Indications
  8. Coste AH, Jaafar S, Parmely JD. Umbilical Hernia. [Updated 2019 Nov 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
  9. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms
  10. Cohen NH. Perioperative management. In: Miller RD, ed. Miller's Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 3.
  11. Australian Society of Anaesthetists [Internet]. Sydney. Australia; Possible complications
  12. UC San Diego Health [Internet]. University of California San Diego. California. US; Hernia Repair Surgery
  13. Health direct [internet]: Department of Health: Australian government; Paraumbilical and umbilical hernia repair
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