Professional Documents
Culture Documents
Adult Umbilical
Hernia Repair
This first page is an overview. For more detailed information, review the entire document.
Intestines
Keeping You
Informed Umbilical Hernia Bulge
Who Gets an
Umbilical Hernia?
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Ten percent of all hernias
in adults are umbilical.2
Umbilical hernias can Abdominal Muscle
suddenly bulge out.
They occur more often
Peritoneum (Abdominal Lining)
in adults over 60 years
Hernia Location
when the muscles
start to weaken.5
Some risk
factors are:
• Older age—muscles
become weaker
• Overweight and
obesity—increased
weight places
pressure on
abdominal muscle
• Chronic straining
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The Condition
An umbilical hernia occurs when part of
the intestine or fatty tissue bulges through
the muscle near the belly button (navel,
umbilicus). Most (9 of 10) umbilical hernias
in adults are acquired. This means that
increased pressure near the umbilicus
causes the umbilical hernia to bulge out.
A reducible hernia can be pushed back
Symptoms
Internal View
Nonsurgic al Treatment
Mesh Repair
Sutured Muscle Repair
Laparoscopic Repair
Open Repair
procedure is often used for small defects.6 Watchful waiting is not usually recommended • Open repairs can be done
except for very small umbilical hernias.7 A with local anesthesia instead
● For an open mesh repair: The hernia of general anesthesia and are
surgical repair is recommended for adults frequently done as outpatient
sac is removed. Mesh is placed beneath who have symptoms, incarceration, thinning procedures.
the hernia site. The mesh is attached of the skin, or uncontrollable ascites.
using sutures sewn into the stronger • Strangulated hernias may
tissue surrounding the hernia. The mesh Because abdominal muscles weaken with have to be repaired as an
extends 3 to 4 cm beyond the edges of age, the hernia can increase in size, and there open approach.
the hernia. The umbilicus is fixed back is a risk of incarceration and strangulation.2
• The use of mesh provides a
to the muscle. Mesh is often used for Abdominal binders that apply pressure and stronger repair and decreases
large hernia repairs and reduces the risk push back the bulge will not repair the hernia. the rate of recurrence.9
that the hernia will come back again.
• Suture repair will result in
● For all open repairs, the skin site is closed a small incision around the
using sutures, staples, or surgical glue. hernia site. Laparoscopic repairs
usually have 3 to 4 smaller scars
● An open repair may be done with at the site of the entry ports.
local anesthesia and sedation
given through an IV.
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Umbilical Hernia Repair
Percent for
Risks Keeping You Informed
Average Patient
E
Wound Infection: Infection at the Open 1.2% Antibiotics and drainage of the wound may be needed. Smoking can
area of the incision or near the organ Laparoscopic 0.9% increase the risk of infection.
where the surgery was performed
Complications: Including surgical Open 2.2% Complications related to general anesthesia and surgery may be higher in
infections, breathing difficulties, Laparoscopic 3.4% smokers, elderly and/or obese patients, and those with high blood pressure
blood clots, renal (kidney) and breathing problems. Wound healing may also be decreased in smokers
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complications, cardiac complications, and those with diabetes and immune system disorders.
and return to the operating room
Pneumonia: Infection in the lungs Open 0.1% Movement, deep breathing, and stopping smoking can help prevent
Laparoscopic 0.2% respiratory infections.
Urinary tract infection: Infection of Open 0.1% Drinking fluids and catheter care decrease the risk of bladder infection.
the bladder or kidneys Laparoscopic 0.4%
Venous thrombosis: A blood clot in Open 0.1% Longer surgery and bed rest increase the risk. Getting up, walking 5 to 6
the legs that can travel to the lungs Laparoscopic 0.3% times per day, and wearing support stockings reduce the risk.
Death Less than 1% Your surgical team is prepared for all emergency situations.
Immediate postoperative pain There is no difference The laparoscopic approach avoids a long incision. There may be a feeling
in pain scores when of tightness in your abdomen because the muscle has been pulled
comparing suture vs. mesh together. Your pain will be managed with nonsteroidal anti-inflammatory
vs. laparoscopic repair by medications and by resting and avoiding straining or lifting.
postoperative day 3 6
Recurrence: A hernia can recur after Suture repairs 0% to 14% The use of mesh or other type of patch repair appears to reduce the rate
the repair of recurrence.11 Obesity, diabetes, and smoking can affect wound healing
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Mesh repairs 0% to 3% 10
and increase recurrence rates.12 Laparoscopic repair is recommended for
recurrent hernias because the surgeon avoids previous scar tissue and
larger hernias.13-14 There is a higher rate of recurrence in older men with
laparoscopic repair.
Seroma: A collection of clear/yellow Open & Laparoscopic Seromas can form around the former hernia site. Removal of fluid with a
fluid Suture repairs 50 of 1,000 sterile needle may be required.
Mesh repairs 60 of 1,000 9
Hematoma: a collection of blood in No difference in the Hematomas are treated with anti-inflammatory medications, elevation, and
the wound site or scrotum occurrence rate between rest. Most will resolve on their own over time.
suture and mesh repair
The data have been averaged per 1,000 cases
The ACS Surgical Risk Calculator estimates the risk of an unfavorable outcome. Data is from a large number of patients
who had a surgical procedure similar to this one. If you are healthy with no health problems, your risks may be below
average. If you smoke, are obese, or have other health conditions, then your risk may be higher. This information is not
intended to replace the advice of a doctor or health care provider. To check your risks, go to the ACS Risk Calculator at
http://riskcalculator.facs.org.
What to Bring
Preparing for Your Operation ●● Insurance card and identification Questions
Home Medication ●● Advance directives (see glossary) to Ask
Bring a list of all of the medications, vitamins,
●● List of medicines About my
and any over-the-counter medicines that
you are taking. Your medications may have ●● Loose-fitting, comfortable clothes Operation:
to be adjusted before your operation. Some • What are the side
●● Slip-on shoes that don’t require
medications can affect your recovery and effects and risks
that you bend over
response to anesthesia. Most often, you will take of anesthesia?
your morning medication with a sip of water. ●● Leave jewelry and valuables at home
• What technique
Anesthesia What You Can Expect will be used to
repair the hernia?
Let your anesthesia provider know if you have An identification (ID) bracelet and allergy bracelet
(Laparoscopic or
allergies, neurologic disease (epilepsy, stroke), with your name and hospital/clinic number will
open? Mesh or
heart disease, stomach problems, lung disease be placed on your wrist. These should be checked
with sutures?)
(asthma, emphysema), endocrine disease (diabetes, by all health team members before they perform
thyroid conditions), or loose teeth; use alcohol or any procedures or give you medication. Your • What are the risks
drugs; take any herbs or vitamins; or if you have a surgeon will mark and initial the operation site. of this procedure
history of nausea and vomiting with anesthesia. for me?
Fluids and Anesthesia • Will you be
If you smoke, you should let your surgical team
An intravenous line (IV) will be started to performing the
know, and you should plan to quit. Quitting before
give you fluids and medication. For general entire operation
your surgery can decrease your rate of respiratory
anesthesia, you will be asleep and pain free yourself?
and wound complications. Quitting also increases
during the operation. A tube may be placed • What level of pain
your chances of staying smoke-free for life. Resources
down your throat to help you breathe during should I expect,
to help you quit may be found at www.facs.org/
the operation. For spinal anesthesia, a small and how will it
patienteducation or www.lungusa.org/stop-smoking.
needle with medication will be placed in your be managed?
Length of Stay back alongside your spinal column. You will be
• How long will it
awake during the operation but pain-free.
If you have local anesthesia, you will usually go be before I can
home the same day. You may stay overnight After Your Operation return to my normal
if you have a repair of a large or incarcerated activities (work,
You will be moved to a recovery room where your
hernia. A laparoscopic repair may result in a driving, lifting)?
heart rate, breathing rate, oxygen saturation,
longer anesthesia time. Complications such as
blood pressure, and urine output will be closely
severe nausea and vomiting or an inability to
watched. Be sure that all visitors wash their hands.
pass urine may also result in a longer stay.
Preventing Pneumonia and Blood Clots
Movement and deep breathing after your
The Day of Your Operation operation can help prevent postoperative
●● You should not eat or drink for at least complications such as blood clots, fluid in
6 hours before the operation. your lungs, and pneumonia. Every hour,
take 5 to 10 deep breaths and hold each
●● You should bathe or shower and clean your
breath for 3 to 5 seconds.
abdomen, especially around the umbilical
area, with a mild antibacterial soap. When you have an operation, you are at risk
of getting blood clots because of not moving
●● You should brush your teeth and rinse
during anesthesia. The longer and more
your mouth with mouthwash.
complicated your surgery, the greater the risk.
●● Do not shave the surgical site; the surgical This risk is decreased by getting up and walking
team will clip the hair near the incision site. 5 to 6 times per day, wearing special support
stockings or compression boots on your legs,
and, for high-risk patients, taking a medication
that thins your blood.
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Umbilical Hernia Repair
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Foods high in fiber include beans, taking narcotics for pain, it may cause you Handwashing Steri-Strips®
bran cereals and whole-grain to feel different for 2 or 3 days. You may
breads, peas, dried fruit (figs, have trouble remembering and feel tired. Wound Care
apricots, and dates), raspberries, You should not drive, drink alcohol, or
blackberries, strawberries, ● Always wash your hands before and
make any big decisions for at least 2 days.
sweet corn, broccoli, baked after touching near your incision site.
potatoes with skin, plums, pears, Nutrition ● Do not soak in a bathtub until your
● When you wake up from the anesthesia,
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apples, greens, and nuts. stitches, Steri-Strips®, or staples are
you will be able to drink small amounts removed. You may take a shower
of liquid. If you do not feel sick, you after the second postoperative
can begin eating regular foods. day unless you are told not to.
● Continue to drink about 8 to 10 ● Follow your surgeon’s instructions on
glasses of water each day. when to change your bandages.
● Eat a high-fiber diet so you don’t strain ● A small amount of drainage from the
while having a bowel movement. incision is normal. If the dressing is
soaked with blood, call your surgeon.
Activity
● If you have Steri-Strips in place,
● Slowly increase your activity. Be sure
they will fall off in 7 to 10 days.
to get up and walk every hour or so
● If you have a glue-like covering over the
M
to prevent blood clot formation.
incision, allow the glue to flake off on its own.
● You may go home the same day for a
simple repair. If you have other health ● Avoid wearing tight or rough clothing.
conditions or complications, such as It may rub against your incisions and
nausea, vomiting, bleeding, or infection make it harder for them to heal.
after surgery, you may stay longer. ● Protect the new skin, especially
Work and Return to School from the sun. The sun can burn
and cause darker scarring.
● After recovery, you can usually
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Umbilical Hernia Repair
More Information
For more information, please go to the American College of Surgeons Patient Education website at www.facs.org/patienteducation.
For a complete review of hernia repair, consult Selected Readings in General Surgery, “Hernia” 2015 Vol. 41 No. 7 at www.facs.org/SRGS.
GLOSSARY REFERENCES
Abdominal X ray: Checks for any Electrocardiogram (ECG): Measures The information provided in this report is chosen from recent
loops of bowel or air-filled sacs. the rate and regularity of heartbeats, articles based on relevant clinical research or trends. The research
E
the size of the heart chambers and below does not represent all that is available for your surgery. Ask
Abdominal ultrasound: Sound
any damage to the heart. your doctor if he or she recommends that you read any additional
waves are used to determine the research.
location of deep structures in the General anesthesia: A treatment
body. A hand roller is placed on top with certain medicines that puts you 1. Klinge U, Prescher A, Klosterhalfen B et al. Entstehung und
of clear gel and rolled across the into a deep sleep so you do not feel Pathosphysiolgie der Bauchwanddefekte. Der Chirurg. 1997;68:293.
abdomen. pain during surgery. 2. Muschaweck U in Umbilical and epigastric hernia repair,
Ascites: Excess fluid in the space Hematoma: A collection of blood that Surgical Clinics of North America. 2003;1207-1221.
between the tissues lining the
abdomen and abdominal organs;
may be due to alcoholism or liver
disease.
Advance directives: Documents
signed by a competent person
giving direction to health care
providers about treatment choices.
Blood tests: Tests usually include a
Chem-6 profile (sodium, potassium,
chloride, carbon dioxide, blood
urea nitrogen and creatinine) and
complete blood count (red blood
PLhas leaked into the tissues of the skin
or in an organ, resulting from cutting
in surgery or the blood’s inability to
form a clot.
Incarceration: The protrusion or
constriction of an organ through
the wall of the cavity that normally
contains it.
Local anesthesia: The loss of
sensation only in the area of the body
where an anesthetic drug is applied or
injected.
Seroma: A collection of serous
3. Malangoni MA, Rosen MD. Hernias. In: CM Townsend, RD
Beauchamp, et al. Textbook of Surgery. Philadelphia, PA. Saunders,
2008.
4. Weinstein PR, Hoff JT. Hernias and Other Abdominal Lesions of the
Abdominal Wall. Current Surgical Diagnosis and Treatment. Eds. L.W.
Way and Gerald M. Doherty. 11th ed. New York: McGraw-Hill, 2004.
783-796.