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Umbilical hernia repair

Definition

Umbilical hernia repair is surgery to repair an umbilical hernia. An umbilical hernia is a weak spot in the inner liningof your belly that allows tissue in your abdomen to push through.

Description

You will probably receive general anesthesia (asleep and pain-free) for this surgery. If your hernia is small, you may receive local anesthesia and medicine to relax you. You will be awake but pain-free.

Your surgeon will make an incision (cut) under your belly button.

• Your surgeon will find your hernia and separate it from the tissues around it. Then your surgeon will either push it back inside your abdomen or remove it.
• Strong stitches will be used to repair the hole or weak spot caused by the umbilical hernia.
• Your surgeon may also lay a piece of mesh over the weak area.

Why the Procedure Is Performed

Children:

Umbilical hernias are fairly common. A hernia at birth will push the belly button out. It shows more when a baby cries because the pressure from crying makes it bulge out more.

In infants, the defect is not usually treated with surgery. Most of the time, 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 for these reasons:

• The hernia is stuck in the bulging position.
• Blood supply is affected.
• The hernia has not closed by age 3 or 4.
• The defect is very large or unacceptable to parents because of how it makes their child look. Even in these cases, your child’s doctor may suggest waiting until your child is 3 or 4 to see if it closes on its own.

Adults:

Umbilical hernias are fairly common in adults. They are seen more in overweight people and in women, especially after pregnancy. Most surgeons recommend surgery to repair them, since they tend to get bigger over time.

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.

Incarcerated abdominal tissue is stuck, and cannot be freed easily. This may cause nausea, vomiting, and bloating. Get medical care right away if you have a hernia that does not get smaller when you are lying down or that you cannot push back in.

Risks

Risks for any anesthesia are:

• Reactions to medicines
• Breathing problems, such as pneumonia
• Heart problems

Risks for any surgery are:

• Bleeding
• Infection

A specific risk of umbilical hernia surgery is injury to the bowel (large intestine). This is rare.

Before the Procedure

An 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 doctor or nurse about any medications, allergies, or history of bleeding problems.

Several days prior to surgery, you may be asked to stop taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, Motrin, Advil, or Aleve, or other blood thinning medications.

After the Procedure

Most umbilical hernia repairs are done on an outpatient basis. Some may require a short hospital stay if the hernia is very large.

After surgery, your doctor and nurse will monitor your vital signs (pulse, blood pressure, and breathing). You will stay in the recovery area until you are stable. Your doctor will prescribe pain medicine if you need it.

Your doctor or nurse will show you how to care for your or your child’s incision at home. You or your child should be able to do all your normal activities in 2 to 4 weeks.

Outlook (Prognosis)

Very few umbilical hernias come back. Recurrence is more likely if:

• The hernia was slightly larger than 1 inch.
• The hernia was repaired without a mesh.
• The hernia is repaired in children younger than 3 years of age.

References

Warner BW. Pediatric surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 71.

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