Umbilical hernia surgery

What is a hernia?

The muscles and tendons of the abdominal walls support the organs inside the abdominal cavity. A hernia forms when a hole or fissure forms in the abdominal wall. This results in the bulging of the peritoneum, i.e. the membrane lining the abdominal cavity and separating the internal organs from the abdominal walls. In conditions of a hernia, there may be a partial displacement of the abdominal organs outwards. The abnormal opening in the abdominal wall is called a hernia gate. The peritoneum, highlighted by the opening, forms the so-called hernia sac. The organs moved into the hernial sac beyond the abdominal wall are called the hernia content - most often these are the loops of the intestine. Initially, the emphasized internal organs may be carried away to the inside of the abdominal cavity. If, due to the formation of peritoneal adhesions, the return of organs is not possible, it is called irreducible hernia. Bowel entrapment in the hernial gates can cause ischemia - a very dangerous situation because intestinal necrosis, rupture of its walls and secondary peritonitis can occur. In order to avoid these serious complications, you should consult a general surgeon. The doctor will assess the degree of the hernia and suggest appropriate treatment before the hernia enlarges and becomes permanent.

How to recognize an umbilical hernia?

A characteristic symptom of an umbilical hernia is a bulge around the navel. The relief may be as small as a few millimeters at first and is difficult to see. Over time, the hernia gradually enlarges - the navel changes its shape and becomes more and more bulging. A hernia may be accompanied by pain in the navel area. Symptoms of an umbilical hernia are most noticeable when you cough, sneeze, or pass stools. The ailments may also worsen during pressure with the hand in order to drain the contents of the hernia to the inside of the abdominal cavity.

Causes of the umbilical hernia

Umbilical hernia in a young child
In the womb, the baby receives oxygen and nutrients from the umbilical cord blood. After the baby is born and the umbilical cord falls off, the anatomical opening in which the blood vessels ran should self-close. If the aponeurosis of the abdominal muscles does not touch the umbilical cord, an umbilical hernia forms.

Umbilical hernia in adults
In adults, umbilical hernia is not a typical umbilical hernia, but a peri-umbilical one. Umbilical hernias in adults are the result of weakness or mechanical damage to the connective tissue around the navel. An increased risk of a hernia occurs in people who have undergone laparoscopic procedures, in which surgical instruments are inserted through the navel. The problem of umbilical hernia appears more often in pregnant women, people with abdominal obesity and ascites. In these conditions, increased pressure may cause a gap in the abdominal wall and the development of a hernia. The genetically determined weaker structure of connective tissue and old age may also be important.

Treatment of umbilical hernia

Umbilical hernia - when to operate?

Umbilical hernias in young children are usually small and are rarely associated with complications. In most cases, they close up before the age of 2-3 (the umbilical ring closes). During this period, observation and regular medical checks are recommended. A hernia that remains persistent, enlarged or sore, may be an indication for surgery. In adults, any umbilical hernia should be treated surgically (unless there are contraindications). Neglect of treatment usually causes further weakening of the abdominal wall and enlargement of the hernia. In addition, dangerous complications such as hernia entrapment and segmental intestinal necrosis can develop. An umbilical hernia belt can be useful while waiting for surgery. Wearing a hernia belt can prevent the hernia from growing but will not heal it.

What does umbilical hernia surgery look like?

The procedure is usually performed under general anesthesia - the patient is asleep and remains unconscious during the operation. The duration of the procedure is 0.5-1.5 hours and depends on the selected surgical method. The choice of the method of umbilical hernia closure depends on the size of the hernia and the surgeon's proficiency in surgical techniques. One of the most used methods is the Mayo method. During the procedure, a semicircular incision is made around the navel and its release. The surgeon separates the meningeal pouch, and if it is removable, there is no need to open it. When an umbilical hernia is large and irreversible, the surgeon cuts the meningeal sac, releases and drains the organs into the abdominal cavity, and then sutures the peritoneum. The hernia gates are closed with an overlapping fascia. If the approximation of the fascia edges is difficult or the tissue is of poor quality, the surgeon may insert a special mesh under the abdominal wall. This mesh additionally strengthens the hernia site and prevents the fascia from redistributing itself. Finally, the navel is sewn to give the belly the most natural appearance possible.

Umbilical hernia surgery - convalescence

 In the first weeks after the procedure, the aim of the procedure is to gradually return to the basic activities of everyday life while protecting the operated area. A physiotherapist while still in hospital teaches safe position changes (standing up, sitting down). In addition, each patient is instructed to stabilize the operated area while coughing or using the toilet. Your doctor may recommend wearing a hernia belt to protect the healing tissues. Recommendations after umbilical hernia surgery relate mainly to the level of physical activity. For 2-3 months after the procedure, you should modify your lifestyle, i.e. avoid lifting heavy loads and exerting excessive use of the abdominal compression. Gradual strengthening of the abdominal muscles should take place under the supervision of an experienced physiotherapist. Return to full activity is usually possible 4-6 months after the procedure.