Umbilical hernia repair
Umbilical hernia surgery; Umbilical herniorrhaphy
Umbilical hernia repair is surgery to repair an
The umbilicus (belly button) is in the center of the lower abdomen. It is the site through which vessels which provide nutrients to the fetus from the mother during development penetrate the fetal abdominal wall.
Description
You will probably receive general anesthesia (asleep and pain-free) for this surgery. If your hernia is small, you may receive spinal, epidural block, or local anesthesia and medicine to relax you. If general anesthesia is not used, you will be awake but pain-free.
Your surgeon will most often make a curved surgical cut following the natural skin lines under your belly button.
- Your surgeon will find your hernia and separate it from the tissues around it. Then your surgeon will gently push the contents of the hernia (either fat or intestine) back into the abdomen.
- Strong stitches will be used to repair the hole associated with the umbilical hernia.
- Your surgeon may also place a piece of mesh over the weak area (usually not in children) to make it stronger.
An umbilical hernia can also be repaired using a laparoscope. This is a thin, lighted tube that lets the surgeon see inside your belly. The scope will be inserted through one of several small cuts. The instruments will be inserted through the other cuts.
If your child is having this surgery, the surgeon will discuss the type of anesthesia your child will receive. The surgeon will also describe how the surgery will be done.
Whenever your child is going in for surgery, it's a big deal for parents and for the child also. I'm Dr. Alan Greene and I'd like to discuss with you how to prepare your child, how to get ready for hernia surgery. The good news is that when the surgery is done you get instant results. Right away the problem's been fixed. And there are just a few steps to take to make the process go as smoothly as possible. Perhaps the first thing is preparing yourself because if you're feeling confident and good about the surgery, then everything will go much easier for you and for your child. And that means getting your questions answered beforehand. And in particular, the question I hear the most from parents is concern about the anesthesia. And that comes often from anesthesia risks that happened back when we were children. Anesthesia was much more dangerous than it is today. The problem was there weren't ways to monitor whether kids were getting enough oxygen to the brain or not. But since those monitors were developed about 20 years or so ago now, anesthesia has become incredibly safe - in fact, often safer than driving to the hospital. Now there other things that are important to do to prepare. First is to remember to take notice if your doctor has ordered any lab tests before the surgery. Perhaps blood tests, perhaps urine tests, maybe nothing was needed. But if it was, you want to make sure you've gotten it done before you end up going to the hospital. The second thing are instructions should've been given to you about when is the last time your child could eat or drink before heading to the hospital. Often it'll be midnight the night before, but whatever you were told be sure to take note of that and really don't cheat on this one. Nothing after what they say. And that leads to point number 3. Whatever medications that your child is taking, prescribed medicines, over-the-counter medicines, need to be taken into account. So, make sure you discuss with your physician, your anesthesiologist or the surgeon beforehand whatever medicines your child is taking and whether they should be taken or skipped after that deadline for food and drink. Next thing that's important, number 4, is to help your child select a favorite toy or stuffed animal, action figure to bring with them to the hospital. This little dog here or something that's comforting for them to have with them along the way. And it's a great idea before the whole thing depending on the age and temperament of your child to act out the whole scenario using their favorite toy. So, for instance, this little dog is not feeling well, hasn't been feeling well for awhile, has to take lots of medications, but the doctors are going to be able to fix it. Can't eat or drink anything after midnight - every step of it you go through. They're a little bit scared and they find out everything is fine and it worked out great and they get some ice cream afterwards and the problem is all gone. But to work it through with them so they get the story and it also helps you feel more prepared. I also suggest giving children something specific and fun to look forward to shortly after the surgery. It might be something as simple as a trip to the movies together or a trip to get ice cream but something that they can focus on. Take the focus a little bit off the surgery itself. Not a bad thing for you too. Then a couple of practical things. I do suggest that before going in you take off any jewelry that the child has, you bathe them, you get rid of even earrings that may stay in all the time or hair clips that may, you don't really want those at the hospital. And it's good to choose comfortable clothes when you go to the hospital, things that are easy on, easy off. It's not a fashion show. Although you may want some pictures of this cause it is a kind of historic moment. And lastly, if your child does develop any kind of fever or rash or cold beforehand, make sure to give them a call and let the folks know what's going on cause it may mean the surgery should be postponed. But the good news is that this kind of minor surgery today in children is extraordinarily safe and when it's done for the right child at the right time really helps move them ahead, move the family ahead. Most parents are really glad afterwards that the surgery has been done.
Why the Procedure Is Performed
CHILDREN
Umbilical hernias are fairly common in children. A hernia at birth pushes the belly button out. It shows more when a baby cries because the pressure from crying makes the hernia bulge out more.
In infants, the problem is not usually treated with surgery. Many times, the umbilical hernia shrinks and closes on its own by the time a child is 3 or 4 years old.
Umbilical hernia repair may be needed in children because:
- The hernia is painful and stuck in the bulging position.
- The blood supply to the intestine is restricted.
- The hernia has not closed by age 3 or 4.
- The hernia is very large or unacceptable to parents because of how it makes their child look. Even in these cases, the surgeon will probably suggest waiting until your child is 3 or 4 to see if the hernia closes on its own since an early umbilical hernia repair is more likely to recur and exposes children to anesthesia earlier in life.
ADULTS
Umbilical hernias also occur in adults. They are seen more in overweight people and in women, especially after pregnancy. They tend to get bigger over time.
Smaller hernias with no symptoms sometimes can be watched. Surgery may pose greater risks than the hernia.
Without surgery, there is a risk that some fat or part of the intestine will get stuck (incarcerated) in the hernia and become impossible to push back in. This is usually painful. If the blood supply to this area is cut off (strangulation), urgent surgery is needed. You may experience nausea or vomiting, and the bulging area may turn blue or a darker color.
To avoid this problem, surgeons often recommend repairing umbilical hernias in adults. Surgery is also used for hernias that are getting larger or are painful. Surgery secures the weakened abdominal wall tissue (fascia) and closes any holes.
Get medical care right away if you have a painful hernia or a hernia that does not get smaller when you are lying down or that you cannot push back in.
So what do you do after your child's had an umbilical hernia repaired? I'm Dr. Alan Greene with some tips for home care after that operation. Well, the first thing to know is that your child will probably go home with a bandage over the surgical site that's best to leave in place until your return visit to the doctor or until your doctor tells you to take it off. And while that bandage is there you want to keep that area pretty dry. That means usually sponge baths, not real bathing, not swimming certainly until it's time for that bandage to come off. Your doctor probably will give some pain medication for your child, especially that first couple days it can be pretty tender afterwards, so it's nice to give that pain medication around the clock when they're awake to kind of stay ahead of the pain instead of waiting until you know that they're uncomfortable. They can pretty well eat what they want once they go home and more or less normal activity. You'll want it kind of quiet for the first 3 or 4 days, but after that they can resume completely normal activity except for rough sports - you probably want to hold off for about a week or so to let that incision really strengthen. When should you call the doctor? It's a good idea to call the doctor if your child develops a new fever sometime afterwards over 101° or so. If their pain is increasing at any point or if they're having trouble urinating would be another reason. If vomiting or nausea develops in the couple of days after surgery. If there's an increase in redness or if it looks to you after the bandage comes off that the wound seems to be coming apart would all be reasons to get back in touch with the doctor. Most children with this operation though have no complications and if there are complications they're pretty easily dealt with. So, enjoy this quiet time with your child and then enjoy getting right back to regular activity sometime in the next week.
Risks
The risks of surgery for umbilical hernia are usually very low unless the person also has other serious medical problems.
Risks of anesthesia and surgery in general are:
- Reactions to medicines or breathing problems
- Bleeding, blood clots, or infection
Risks of umbilical hernia surgery include any of the following:
- Injury to the small or large intestine (rare)
- Hernia comes back (small risk)
Before the Procedure
Your surgeon or anesthesia doctor (anesthesiologist) will see you and give you instructions for you or your child.
The anesthesiologist will discuss your (or your child's) medical history to determine the right amount and type of anesthesia to use. You or your child may be asked to stop eating and drinking 6 hours before surgery. Make sure you tell your health care provider about any medicines, allergies, or history of bleeding problems.
Several days before surgery, you may be asked to stop taking:
- Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, Motrin, Advil, or Aleve
- Other blood-thinning medicines
- Certain vitamins and supplements
After the Procedure
Most umbilical hernia repairs are done on an outpatient basis. This means you will likely go home on the same day. Some repairs may require a short hospital stay if the hernia is very large.
After surgery, your provider will monitor your vital signs (pulse, blood pressure, and breathing). You will stay in the recovery area until you are stable. Your provider will prescribe pain medicine if you need it.
Follow instructions on how to care for your or your child's incision at home. Your provider will tell you when you or your child resume your normal activities. For adults, this will be in 2 to 4 weeks. Children can likely return to most activities right away.
Outlook (Prognosis)
There is always a chance that the hernia can come back. For healthy people, the risk of it coming back is very low.
References
Cameron J. Management of inguinal hernia. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:663-716.
Nathan AT. The umbilicus. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 125.
Poulose BK, Carbonell AM, Rosen MJ. Hernias. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 45.
Sujka JA, Holcomb GW. Umbilical and other abdominal wall hernias. In: Holcomb GW, Murphy JP, St. Peter SD, eds. Holcomb and Ashcraft’s Pediatric Surgery. 7th ed. Philadelphia, PA: Elsevier; 2020:chap 49.
Version Info
Last reviewed on: 1/24/2023
Reviewed by: Robert A. Cowles, MD, Professor of Surgery (Pediatrics), Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
