What is Umbilical Hernia Repair?
Umbilical hernia repair is a surgical procedure performed for the treatment of a medical condition called an umbilical hernia.
A hernia is a bulge formed when the internal organs of your abdominal cavity are pushed through a weakened spot in your abdominal wall. An 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.
The umbilical cord passes through a space between the abdominal muscles that usually closes soon after birth. This closure may not always happen adequately resulting in a weak spot where a hernia may develop. Umbilical or paraumbilical hernias are more common in infants, especially premature babies. However, adults can also develop the condition, especially women and obese individuals. Other risk factors include previous abdominal surgery, multiple pregnancies, excess fluid in the abdomen, and a persistent cough.
During an umbilical hernia repair, your surgeon pushes the hernia back into the abdomen and the weakened abdominal wall area is sewn closed or strengthened with a synthetic mesh. This is performed either through an open surgery or a minimally invasive laparoscopic surgery.
Indications for Umbilical Hernia Repair
Your physician may recommend umbilical hernia repair when your hernia is enlarged (larger than half an inch) or causing severe pain and discomfort that is preventing you from functioning normally. Sometimes, umbilical hernias may also get trapped and strangulated, thereby cutting off the blood supply to the trapped part. This may cause death of the trapped tissue (necrosis) and result in severe complications. A trapped or strangulated umbilical hernia is considered a medical emergency requiring immediate surgery. Symptoms of an incarcerated/strangulated umbilical hernia include:
- Tender, painful, swollen, or discoloured bulge
- Severe abdominal pain
Preparation for Umbilical Hernia Repair
Preoperative preparation for umbilical hernia repair will involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from medications such as blood thinners or anti-inflammatories for 1 to 2 weeks prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You may be instructed to shower with an antibacterial soap the night or morning prior to the operation.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery has been explained.
Procedure for Umbilical Hernia Repair
Your surgeon may perform either an open or a laparoscopic surgery to repair the umbilical hernia. The surgery takes around 30 to 45 minutes depending upon the technique used. The surgery is performed usually under the influence of general or local anaesthesia.
Open Umbilical Hernia Repair
Your surgeon will make a single incision of 5 to 10 cm long just below or above the navel to access the hernia over the bulge site. Your surgeon pushes the part of the intestine that is protruding back into its normal position inside your abdomen. The weakened spot of the abdominal wall will then be stitched with sutures. In cases of large hernias, your surgeon may place a mesh patch for strengthening the weak abdominal wall. The skin will be sutured with dissolvable stitches and a dressing will be applied to the wounded area.
Laparoscopic Umbilical Hernia Repair
Your surgeon will make two to three small incisions around the hernia bulge site near the belly button. A laparoscope (a fibre-optic tube with a light source and camera attached to it) and other special instruments are inserted through the incisions. The video camera attached to the laparoscope will send magnified images to a monitor, which will guide your surgeon throughout the surgery. Your surgeon will push the bulge into the abdominal cavity and the abdominal wall will either be stitched or a mesh will be placed to support the weak part of your abdominal wall. Once the repair is complete, the scope and other tools are withdrawn, and the small abdominal incisions are closed with stitches or surgical tape.
Advantages of a laparoscopic procedure over the open surgical method include shorter hospital stays, smaller incisions, less post-operative pain, and a faster recovery.
Postoperative Care Instructions and Recovery
In general, postoperative care instructions and recovery after umbilical hernia repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will monitor your vital signs as your recover from the effects of anaesthesia.
- Most patients are able to go home the same day or the next day if it is a laparoscopic procedure or after two to three days if it is an open surgery.
- You may notice some pain, swelling, and discomfort around the belly button. Pain and anti-inflammatory medications are provided as needed.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities, lifting heavy weights, and driving at least for the first few weeks. A gradual increase in activities over a period of time is recommended.
- Typically, you will be able to return to work and resume your daily activities in a week or two after surgery.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Umbilical Hernia Repair
Umbilical hernia repair surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection at the incision site or mesh
- Pain or numbness around the navel
- Blood or fluid accumulation
- Anaesthetic reactions
- Recurrence of hernia
- Blood clots
- Injury to surrounding soft-tissue structures or organs