Umbilical Hernia Repair

What is an umbilical hernia?

An umbilical hernia occurs when an internal structure pushes out through a weakness or defect in the abdominal wall around the belly button. Umbilical hernias are quite common, and some people don’t even realise they have one. Others will be aware of a bulge at the belly button which tends to go away when they lie down (doctors describe this as being reducible) but pop out again when they stand up, cough, sneeze or exert themselves. An umbilical hernia will not get better on its own and most patients are advised to have them repaired. An umbilical hernia may gradually enlarge over a period of time and sometimes they can be associated with some local discomfort. Less frequently an umbilical hernia can become stuck i.e. they become irreducible. In this situation they can become more uncomfortable, and this can lead to more serious problems such as strangulation or bowel obstruction. If this happens urgent admission to hospital and emergency surgery is usually required.

When is an umbilical hernia repair recommended?

For small hernias that are not causing any symptoms a surgical repair may not be necessary. All surgery carries the risk of complication so for some patients watchful waiting is advised. A hernia repair is usually advised if a hernia becomes symptomatic i.e., starts enlarging causing discomfort, or generally interfering with the activities of daily living. The inability to ‘reduce’ or push back the bulge into the abdomen usually means the hernia is ‘incarcerated’ this requires urgent treatment.   

What does the procedure involve?

When patients arrive at the hospital, they will meet a nurse, the anaesthetist and their surgeon. Most umbilical hernias are repaired under a general anaesthetic. The operation normally involves making a small incision beneath the belly button. The surgeon will free up the hernia and push it back into the abdomen. The defect that is left, if small, is repaired with stitches. For larger defects a soft, synthetic, non-absorbable mesh is used to reinforce the repair. This is fixed in place with a few stitches, placed in the abdominal wall. The wound is closed with a dissolvable suture or wound glue. The operation takes around 40 minutes to perform. Patients are usually able to go home later the same day.

What are the potential risks and complications?

There are small risks associated with any operation. Pre-operative assessments are made of any heart or lung conditions, as well as any coexisting medical condition. During the hospital admission patients wear stockings to prevent thrombosis (blood clots). Wound infections are uncommon after this type of surgery. When they do occur patients may need a course of antibiotics. Sometimes bruising may occur around the wound or a swelling develop beneath the wound. This is usually blood and / or tissue fluids which accumulates in the space where the hernia was. The fluid will normally gradually resolve. Very occasionally a collection of fluid may need to be drained. Patients should contact their surgeon if after the operation they develop any of the following:

• Redness around or drainage the incision 
• Fever 
• Bleeding from the incision
• Pain that is not relieved by medication or pain that suddenly worsens

In the longer term there is a small risk of the hernia recurring.

After the procedure

We encourage all patients to stay active following surgery. Walking regularly is the most useful exercise after the operation. Following the operation patients should avoid heavy lifting for four to six weeks. After about 4 weeks patients should be able to increase their exercise activities. Starting with gentle rhythmic exercises such as cycling or cross-training and gradually building up to their normal exercise regimen. Provided there are no wound problems swimming can also be good at this stage.Patients should be able to return to work within one or two weeks but if their job involves any strenuous activities, they may need to be off work for longer or carry out only light duties. Patients can usually drive again after one to two weeks but the surgeon will provide specific instructions regarding this.