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Umbilical Hernias - Diagnosis, Treatment and Surgery

Umbilical Hernia Surgery

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Updated January 03, 2009

Umbilical Hernia Image

Umbilical Hernia Image

Photo © A.D.A.M.

What is an Umbilical Hernia?

An umbilical hernia happens when a weakness in the muscle around the umbilicus, or belly button, allows the tissues of the abdomen to protrude through the muscle. The umbilical cord, or the cord that delivers nutrients from the mother to the fetus, goes through the abdominal muscles, creating an area where a hernia can easily form.

An umbilical hernia is typically small enough that only the peritoneum, or the lining of the abdominal cavity, pushes through the muscle wall. In severe cases, portions of the intestine may move through the hole in the muscle.

Who Is At Risk For an Umbilical Hernia?

Umbilical hernias are typically present at birth and may seem to appear and disappear, which is referred to as a "reducible" hernia. The hernia may not be noticeable unless the patient is crying, pushing to have a bowel movement, or another activity that creates abdominal pressure. The visibility of a hernia makes it easily diagnosable, often requiring no testing outside of a physical examination by a physician.

When umbilical hernias are present in an adult, it is typically after surgery in that area, during or after pregnancy, or in those who are overweight. Unlike children, adults are no longer growing so an umbilical hernia does not heal itself in the majority of cases.

Umbilical Hernia Treatment

For most children, an umbilical hernia will heal itself. Usually children “grow out of” a hernia by the age of three, as the abdominal muscles strengthen and grow with the child. In some cases though, surgery may be necessary.

When is Umbilical Hernia Surgery Necessary?

A hernia may require surgery if:

  • It fails to heal by the age of four or five on its own
  • It is large and is not expected to heal on its own
  • It is cosmetically unappealing
  • The patient is an adult

When Is Umbilical Hernia an Emergency?

A hernia that gets stuck in the “out” position is referred to as an “incarcerated” hernia. While an incarcerated hernia is not an emergency, it should be addressed, and medical care should be sought. An incarcerated hernia is an emergency when it becomes a “strangulated hernia” where the tissue that bulges outside of the muscle is being starved of its blood supply. This can cause the death of the tissue that is bulging through the hernia.

A strangulated hernia can be identified by the deep red or purple color of the bulging tissue. It may be accompanied by severe pain, but is not always painful. Nausea, vomiting, diarrhea and abdominal swelling may also be present.

Umbilical Hernia Surgery

Umbilical hernia surgery is typically performed using general anesthesia and can be done on an inpatient or outpatient basis. Special care should be taken to adequately prepare children for the surgery.

Once anesthesia is given and the patient is asleep, surgery begins with an incision under the umbilicus, or belly button. Once the incision is created, the portion of the abdominal lining that is protruding through the muscle is isolated. This tissue is called the “hernia sac”. The surgeon returns the hernia sac to the abdomen, in its proper position.

If the defect in the muscle is small, it may be sutured closed. The sutures will remain in place permanently, preventing the hernia from returning in the future.

For large defects, the surgeon may feel that suturing is not an adequate way to repair the hole in the muscle. In this case, a mesh graft will be used to cover the hole in the muscle. Imagine the surgical version of the screen that is used in windows being used to cover the hole and sewn into place. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.

If the suture method is used with larger muscle defects (approximately the size of a quarter or larger), the chance of reoccurrence is increased. The use of mesh in larger hernias is the standard of treatment, but it may not be appropriate if the patient has a history of rejecting surgical implants or another condition that prevents the use of a mesh graft.

Once the mesh is in place or the muscle has been sewn, the incision can be closed. The incision is usually disguised in the normal folds of the belly button. So once it has healed, it is not noticeable. The incision is typically closed with sutures that are removed at a follow up visit with the surgeon.

Recovering From Umbilical Hernia Surgery

Most hernia patients are able to return to their normal activity within two to four weeks. The belly will be tender, especially for the first week. During this time, the incision should be protected during activity that increases abdominal pressure by applying firm but gentle pressure on the incision line.

Activities that indicate the incision should be protected include:

  • Rising from a seated position
  • Sneezing
  • Coughing
  • Bearing down during a bowel movement
  • Vomiting

Sources

Umbilical Hernia Surgery. National Institutes of Health http://www.nlm.nih.gov/medlineplus/ency/article/002935.htm.

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