Umbilical hernia repair

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An umbilical hernia repair is an operation to return an umbilical hernia to your abdomen (tummy) and to repair the weak area in your abdominal wall that caused the hernia. You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About umbilical hernia Diagnosis of an umbilical hernia What are the alternatives to surgery? Preparing for your operation What happens during umbilical hernia repair? What to expect afterwards Recovering from umbilical hernia repair What are the risks?

About umbilical hernia

You can get an umbilical hernia if a weakness develops in your abdominal wall in the area around your belly button (where your umbilical cord was attached as a baby). This allows your abdominal lining, some internal fat or even a loop of your bowel to push forward through the weak area to create a lump in or around your belly button. A hernia through the centre of your belly button is called an umbilical hernia. A hernia just above your belly button is called a paraumbilical hernia. An umbilical hernia repair operation aims to return the contents of the hernia back into your abdomen and repair the weak area in your abdominal wall.

Diagnosis of an umbilical hernia

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will examine the bulge or swelling. This may be when you're standing up or lying down. He or she will check if the bulge can be pushed back in, and may ask you to cough while placing a finger over the hernia to see if there is a change in the swelling. Your GP may also refer you for an ultrasound scan to confirm a diagnosis.

What are the alternatives to surgery?

In adults, surgery to repair the weakness in your abdominal wall is the only effective treatment for an umbilical hernia. If you dont have an operation to repair an umbilical hernia, its likely to get larger and become more uncomfortable. There is also a risk that an umbilical hernia can strangulate if it's left untreated. This is when the contents of the hernia (usually part of your abdominal lining, internal fat or bowel) gets trapped outside of your abdomen and may become damaged. The risk of complications increases with the size of the hernia. Once an umbilical hernia has been diagnosed, your doctor will usually recommend that you have it repaired. In children under five, umbilical hernias often get better on their own and there may be no need for surgery. However, some children may need an operation if it doesn't get better by the time they are of school age or if the hernia becomes large or causes discomfort.

Preparing for your operation

Your surgeon will explain how to prepare for your umbilical hernia repair. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest or wound infection, which can slow your recovery. An umbilical hernia repair is usually done as a day-case operation. This means you have the operation and go home the same day. It may be done under general anaesthesia, which means you will be asleep during the operation. Alternatively, you may prefer to have the surgery under local or regional anaesthesia. This completely blocks pain from around your belly button area and you will stay awake during the operation. You may also be given a sedative this relieves anxiety and helps you to relax. Your surgeon or anaesthetist will advise which type of anaesthesia is most suitable for you. If youre having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice. Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during umbilical hernia repair?

An umbilical hernia repair operation usually takes around 30 minutes, depending on the method your surgeon will use. There are two methods used in an umbilical hernia repair operation open and keyhole (laparoscopic). Your surgeon may recommend that you have keyhole surgery if your hernia has reoccurred after a previous operation.

Open surgery
Your surgeon will make a small cut just above or below your belly button, and will push the hernia back into place. If the hernia is small, your surgeon will stitch the weak area within your abdominal wall. For a larger hernia, your surgeon will repair the defect with a piece of synthetic mesh. He or she will close the cut with dissolvable stitches or clips and cover it with a dressing.

Keyhole surgery
Your surgeon will make two or three small cuts in your abdomen, away from the hernia. He or she will then insert a tube-like telescopic camera (laparoscope) which will display the hernia on a monitor. Your surgeon will pass specially designed surgical instruments through the other cuts and repair the hernia. He or she will clip a synthetic mesh to the undersurface of your abdominal muscles with stitches, covering the hernia. Your surgeon will close the cuts with dissolvable stitches and cover it with a dressing.

What to expect afterwards

If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. After a local anaesthetic, it may take several hours before the feeling comes back into your abdomen. Take special care not to bump or knock the area. You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your umbilical hernia repair. If your hernia was large and repaired using a mesh, you may have a fine tube running out from the wound. You will need to stay in hospital for one to two days until this is removed. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeons advice.

Your nurse will give you some advice about caring for your healing wound(s) before you go home. You may be given a date for a follow-up appointment. The dissolvable stitches will usually disappear in about seven to 10 days.

Recovering from umbilical hernia repair

It usually takes two to three weeks to make a full recovery from an umbilical hernia repair, but this varies between individuals, so its important to follow your surgeons advice. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. Its important to keep the area dry for one to two days after your operation. You will need to take it easy in the first few days. You should be able to return to normal activities after about two to three weeks. Light exercise, such as walking, will help to speed up your recovery. You should be able to return to work once you feel able, but if your work is strenuous and involves heavy lifting or puts a strain on your abdominal muscles, seek advice from your doctor first. Children should stay off school for a few days. Eat plenty of vegetables, fruit and high-fibre foods, such as brown rice and wholemeal bread and pasta, as this will help to prevent constipation, which can cause straining and discomfort.

What are the risks?

As with every procedure, there are some risks associated with an umbilical hernia repair. We havent included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. After an umbilical hernia repair, you will have some pain, bruising and minor swelling in your lower abdomen. The side-effects are usually milder after keyhole surgery.

Complications
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT). Specific complications of an umbilical hernia repair include:

an infection in your wound this will cause redness, pain, swelling or a discharge from your wound and you will need treatment with antibiotics the umbilical hernia reoccurring youre more at risk of this happening if you smoke, are overweight or your wound gets infected damage to your bowel during the operation

Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, June 2012. For answers to frequently asked questions on this topic, see FAQs. For sources and links to further information, see Resources.

Hernia

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A hernia occurs when part of an internal body organ protrudes through weak muscles. Usually the intestine or fatty tissue in the abdomen bulges out through the abdominal wall that surrounds the muscles. Hernias often lead to no symptoms. In some cases, there may be mild to severe pain. There is a risk of hernias becoming strangulated and restrict blood supply, because the area through which they protrude may exert pressure on the blood vessels and constrict them. Once blood supply is cut off, immediate medical care is required as the tissue needs oxygen to survive. There are different types of hernia such as inguinal hernias, femoral hernias, umbilical hernias and incisional hernias.

Symptoms of Hernia
Hernias are classified according to the part of the body in which they occur. Some hernias are more common than others. In most cases, hernias lead to bulging and pain in the affected area. There may also be certain symptoms which are specific to the location of the hernia. The common symptoms of hernia include:

Inguinal Hernia: These hernias occur as a bulge in the groin area. They may develop on either side of the pubic bone and are more common in men. The protrusion increases when you change positions, cough or perform any physical activity. Straining while urinating or during bowel movements can also lead to a more pronounced bulge in the affected area. These hernias often lead to a heavy sensation which is more prominent when lifting something or while bending. Inguinal hernias can lead to swelling and pain in the testicles in men because the bulging portion of the intestine may descend into the scrotum. Femoral Hernia: These hernias occur when a portion of the intestine bulges out through a weak area in the abdominal wall near the thigh. The bulge may be detected in the upper region of the thigh, under the groin. The femoral artery and vein pass through this region. Physical activities which exert strain on the groin or thigh area can lead to pain. Umbilical Hernia: These hernias are seen as protruded areas near the navel. They are common in babies. Umbilical hernias occur when the abdominal muscles fail to close properly around the belly button while the baby is inside the womb. This causes the intestine to bulge through the weak area. These hernias may also occur due to certain rare diseases. They usually do not cause any pain, but the protrusion may become more pronounced during movement. Babies with umbilical hernias may not manifest any symptoms in the early years of life, but may do so later on. Incisional Hernias: These hernias develop after abdominal surgery. They occur in a scar and are seen as a prominent bulge. Medical conditions that exert pressure on the abdominal wall and strenuous physical activities may also lead to an incisional hernia.

Causes of Hernia

Some abdominal hernias may be present at birth while others may occur in the later years. The causes for hernia are varied and range from irregularities during fetal development, openings in the abdominal cavity and weakness of the abdominal wall. Hernias can occur due to any condition that leads to increased strain on the abdominal cavity. Some of the conditions include:

Lifting heavy objects Obesity Persistent coughing Strain while urinating or during bowel movements Chronic lung disease Accumulation of fluid in the abdominal cavity Family history of hernias

Remedies for Hernia

Hernia treatment usually involves surgery especially if they are large and painful. Surgery helps to make the weak abdominal wall more secure and closes up existing holes with cloth patches. For umbilical hernias, doctors usually recommend waiting until the child is five years old. In some cases when the bulging sac becomes strangulated and blood supply is cut off, emergency surgery is required. If immediate medical attention is not received, the bulging area may lose blood supply completely and die. It is advisable to consult a doctor if you notice any symptoms of a hernia. Natural remedies may offer some relief from the symptoms of hernia, but they will under no circumstance suffice as an alternative to conventional medical treatment. Also, keep in mind that most home remedies are not subjected to rigorous testing and results can vary greatly, with some even posing a health risk. Always consult with your doctor before trying any home treatment.

The herb licorice has long been used as a healing remedy for various ailments such as respiratory trouble and sore throat. Licorice root may also encourage healing of damaged areas in the stomach lining and esophagus caused by a hernia. This will help to alleviate burning and pain in the chest and throat. It is important to consult your doctor before using licorice or any other herbs for hernia treatment. Ginger root is known to help in protecting the esophagus and stomach from damage due to buildup of gastric acids and bile. But keep in mind that in some cases, ginger root may lead to a stomach upset. Hernias in the abdominal region may lead to acid reflux. The herb chamomile helps to soothe the lining of the digestive tract and reduces the production of stomach acids. It also helps to soothe esophageal lining. Some people may experience nausea after using chamomile.

Marshmallow root has many health benefits such as improved digestion and decreased production of digestive acids. It may thus help to alleviate hernia-related symptoms. However in rare cases it may trigger diarrhea. Hawthornia is an herbal supplement which helps to strengthen the muscles that support and protect the internal organs. It may even help to stop a hernia from developing and prevent its recurrence. Hawthornia consists of herbs such as citrus seed, hawthorn and fennel. The herb Shepherd s purse helps to relieve inflammation, pain and swelling. It can also reduce bleeding and infection. Its tincture may be applied externally to the hernia-affected area to alleviate the symptoms. The herb may also be taken internally in the form of supplements. Hernia pain may be relieved through acupuncture. The stimulation of certain pressure points is known to help in reducing pain and discomfort. Such alternative therapies may not be effective in curing the problem, but they may help in dealing with the symptoms. Engage in gentle exercises which target the core abdominal muscles. Regular practice of such exercises helps to shed excess body weight and thus lowers the pressure on the abdominal muscles. However avoid any strenuous exercise or heavy lifting. It is best to have a discussion with your doctor before starting any exercise program. Avoid exercising immediately after eating and wait for about two to three hours. Stress can aggravate stomach ailments and acid reflux. Therefore it is advisable to manage stress effectively through various techniques such as yoga, breathing exercises and meditation. Ice compresses are one of the best home remedies for hernia. They may help to alleviate pain and swelling caused by the hernia.

Avoid applying any heat or pressure to the affected area. Avoid exercising on a full stomach. Tight clothes can exert pressure on the abdomen and hence it is advisable to wear only loose, comfortable clothing. Keep the head of your bed elevated by about six inches as this will prevent gastric acids from travelling back into the esophagus during sleep. Use bricks to elevate the bed frame and avoid using pillows as they may increase stress on the abdomen. Avoid eating large meals and opt for smaller, frequent meals throughout the day. Refrain from lying down or bending soon after eating. Avoid consuming alcohol.

Diet for Hernia

In order to prevent recurrences, the diet for hernia should be high in protein and low in fat. A low intake of protein and excess consumption of fat can cause the abdominal walls to become weak, thus increasing the risk of hernia. Therefore it is advisable to include in your diet foods that are rich in protein such as cottage cheese, tuna and chicken. Also opt for low-fat milk and dairy products to

control your fat intake. Fiber is also an important addition to the diet. Consume plenty of fresh fruits such as apples and pears as they are rich in fiber. Nuts, whole grains and beans are also excellent sources of fiber. A good intake of fiber will promote better bowel movements and alleviate constipation. This will help to reduce the symptoms of hernia.

Suggestions for Hernia

Here are some tips that help in managing hernia symptoms:

Maintain a healthy body weight by following a low-calorie, nutritious diet. Also practice regular exercise especially if you are overweight. Include plenty of fresh vegetables, fruits and whole grains in your diet. These are full of nutrients and also high in fiber. Exercise caution when lifting anything heavy or while weight lifting. Always bend from the knees instead of the waist when lifting heavy objects. Persistent coughing can aggravate symptoms of hernia. Therefore seek medical care in case you suffer from allergies or any other respiratory problems. Smoking can lead to constant coughing which can exert strain on the abdominal muscles. Therefore it is advisable to quit smoking.

An umbilical hernia is a protrusion around the navel (umbilicus) that may contain part of the intestine and/or the fatty membrane found inside the abdomen (omentum). Hernias often protrude through areas of muscle weakness such as around the navel. This is the area where blood vessels from the mother supply the developing fetus with nutrients through the umbilical cord. After birth, the umbilical cord is severed, leaving the bellybutton as its lifetime reminder. Umbilical hernias in babies (congenital) usually resolve spontaneously by ages 1 to 2.

An adult umbilical hernia (acquired) occurs when the connective tissue (fascia) of the abdominal wall becomes weak around the area of the navel. The weakening occurs over a period of years until eventually the abdominal contents, encased in a sac, protrude through the abdominal wall, and a bulge forms around the umbilicus. A newly formed umbilical hernia is usually small and contains only the fatty omentum. However, as more of the abdominal contents (transverse colon, small intestine, greater omentum) push into the sac, the umbilical hernia can grow in size. A reducible hernia can easily be returned to the abdominal cavity. When the hernia can no longer be reduced, it is called incarcerated; these hernias have a high risk for losing the blood supply that keeps the tissue alive (strangulation). For that reason, repair of an umbilical hernia is recommended as soon as possible after it is discovered. Risk: Umbilical hernias are most common in infants. In an adult, any condition that causes buildup of pressure
against the abdominal wall may contribute to umbilical hernia formation. This includes extreme obesity, heavy lifting, accumulation of abdominal fluids (ascites), coughing, straining with urination or defecation, chronic obstructive pulmonary disease (COPD), or even multiple pregnancies.

Incidence and Prevalence: Of the half million hernia operations performed in the US every year, about 14% are
umbilical hernia repairs (Golladay). Congenital umbilical hernias generally close spontaneously by ages 1 or 2 (Nicks). Slightly more women than men are treated for umbilical hernias, with a ratio of 1.7 to 1 (Golladay). As with all abdominal hernias, the prevalence of umbilical hernia increases with age, and umbilical hernias are more common in individuals of African ancestry (Golladay).

Source: Medical Disability Advisor

Diagnosis
History: Individuals with umbilical hernia report a central mid-abdominal bulge that may expand when the individual
coughs or strains the abdomen. Pain in the area of the hernia is not uncommon with coughing or straining. A careful review of symptoms should seek other medical conditions that may be associated with increased intra-abdominal pressure.

Physical exam: The presence of an umbilical hernia is identified by a bulge or a palpable defect at the level of the
umbilicus. There may be discoloration of the skin overlying the hernia.

Tests: The diagnosis is made based on the history and physical exam, and tests are usually not needed. However,
the physician may useCT imaging, ultrasound, or x-ray aided by contrast material to visualize the herniated contents.

Source: Medical Disability Advisor

Treatment
A small umbilical hernia that is easily pushed back into the abdomen (reduced) in an adult of normal weight may be watched closely, particularly if the individual is a poor surgical risk or elderly. Repair of umbilical hernias is recommended in all other adults. Large umbilical hernias are often treated with the Mayo procedure, which uses an implanted polyurethane mesh to provide support and hold the herniated sac inside the abdomen. Trusses were sometimes used in the past when surgery was a more dangerous proposition but have fallen out of favor since they can injure delicate skin and bowel and mask signs of strangulation. Corsets and binders are sometimes used on a temporary basis before surgery or for individuals who are not surgical candidates.
Source: Medical Disability Advisor

Prognosis
Surgical repair is recommended in most situations since small umbilical hernias, left untreated, can expand and become problematic. Umbilical hernia repair is often done at outpatient surgery centers, and most healthy individuals who undergo mesh repair can be discharged on the same day as the surgery. Rarely is there recurrence of the condition following surgical treatment (less than 3% of the time) (Jeyarajah). Potential surgical complications include infection, bleeding, and persistent pain (Golladay).
Source: Medical Disability Advisor

Rehabilitation
Following abdominal surgery to repair a hernia, intermittent positive pressure breathing exercises may be necessary to prevent pulmonary complications. Certain exercises such as progressive relaxation and deep-breathing techniques may be performed to reduce postoperative pain and speed recovery. They may be performed several times a day until pain from inhalation/exhalation is less noticeable. Physical therapists instruct individuals to hold a pillow to the abdomen when walking, coughing, or laughing. The pillow acts as a splint in place of the weakened abdominal muscles and decreases the amount of pain perceived during these activities. While lying on his or her back, the individual performs exercises such as pelvic tilts, in which the lower back is flattened against the bed, and neck bends, in which the neck is bent forward. These exercises strengthen the abdominal muscles. Ankle flexes, knee bends, and crossed-leg muscle contractions (all performed while lying on the back) help increase circulation and make walking easier. These exercises are especially valuable during the first 48 hours after surgery and should be performed 3 to 5 times a day during this time. Individuals may continue these exercises for 4 to 6 weeks until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.
Source: Medical Disability Advisor

Complications
Complications of umbilical hernia may include incarceration of the herniated sac and its contents. Consequently, the flow of blood to the tissue within the incarcerated sac may be cut off (strangulation), and the tissue may then start to die (necrosis). Tissue necrosis may be accompanied by bacterial infection, abdominal pain, vomiting, and shock. This condition is a surgical emergency. Other possible complications of umbilical hernia include rupture of the hernial sac, infection, abdominal distention, pneumonia, fluid in the lungs (pulmonary edema), skin discoloration from liver dysfunction (jaundice), intestinal bleeding (hemorrhage), and kidney (renal) problems.
Source: Medical Disability Advisor

Return to Work (Restrictions / Accommodations)

Restrictions on lifting, climbing, and strenuous physical activity should be expected for several weeks following surgical repair of umbilical hernia. After recovery, the individual can usually return to work in full capacity with no disability. Rarely, an umbilical hernia will recur after being repaired surgically. If this happens, reassignment to an alternative job requiring less physical strain may be considered. The risk of recurrence can be reduced by addressing risk factors such as obesity, chronic constipation, smoking, and cough.
Source: Medical Disability Advisor

Failure to Recover
If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

Does individual have a mid-abdominal protrusion that expands with coughing or straining the abdomen? Does pain occur in the area of the bulge when coughing or straining? Is skin overlying the hernia discolored? Can the mass that protrudes through the incision site be pushed back into the abdominal cavity? That is, is it reducible? Was diagnosis of umbilical hernia confirmed? Were any imaging studies needed to visualize hernia and confirm diagnosis? If diagnosis is uncertain, were other conditions with similar symptoms ruled out?

Regarding treatment:

Since even small hernias can expand, has a pre-existing umbilical hernia now become problematic? Is

surgical repair now warranted? Was surgical repair successful? Did individual experience any complications associated with the hernia, such as tissue necrosis? Will further procedures be necessary? Were any complications associated with the procedure or anesthesia? If surgical repair is not an option, what are extenuating circumstances? How is the hernia being managed?

Regarding prognosis:

Did the hernia recur despite surgical repair? Does individual have a coexisting condition, such as severe obesity, diabetes, or cancer, that may complicate treatment or affect recovery