An umbilical hernia occurs when tissue, such as fat or a portion of the intestine, pushes through a weak spot in the abdominal wall near the umbilicus. This weakness allows a visible bulge to form, which can sometimes cause discomfort. While umbilical hernias in infants often close spontaneously, those in adults are unlikely to resolve and tend to worsen over time. Surgical repair is the definitive treatment for adults to alleviate symptoms and prevent severe complications. Complications like incarceration (tissue becoming trapped) or strangulation (blood supply being cut off) are medical emergencies that surgery is designed to avoid.
Preparing for the Procedure
Preparation begins with a thorough medical evaluation, which may include blood work and an electrocardiogram, especially for older patients or those with existing health conditions. Patients must stop taking certain medications days or weeks before the procedure, particularly blood thinners like aspirin, which increase the risk of excessive bleeding. The surgical team manages this medication adjustment with the patient’s primary care provider.
Fasting is mandatory, requiring the patient to refrain from eating or drinking anything, including water, often starting at midnight the night before surgery. This safety precaution prevents the aspiration of stomach contents into the lungs while under anesthesia. The choice of anesthesia is determined by the surgeon and anesthesiologist; general anesthesia is common for complex or laparoscopic repairs. For small, straightforward repairs, local anesthesia with monitored sedation may be used to numb the area while keeping the patient relaxed.
Detailed Steps of the Repair
Umbilical hernia repair uses one of two primary approaches: open repair (herniorrhaphy) or minimally invasive laparoscopic surgery. The open method is the traditional technique, involving a small curved incision made directly below the navel. The surgeon carefully dissects the tissues to identify and isolate the hernia sac, which contains the protruding abdominal contents.
The contents of the sac, usually fatty tissue or intestine, are gently pushed back into the abdominal cavity, a process called reduction. For small defects, the surgeon performs a primary suture repair, stitching the edges of the abdominal wall tissue (fascia) directly together. The Mayo repair is a specialized open technique that involves overlapping the fascial edges in a “vest-over-pants” fashion and securing them with strong sutures for double-layered reinforcement.
For larger defects or in patients with risk factors for recurrence, a prosthetic mesh is used to reinforce the weakened area. The mesh material, which can be synthetic or biologic, acts as a scaffold for new tissue growth. It may be placed either over the fascia (onlay) or beneath the muscle layer (sublay or preperitoneal). Mesh reinforcement is associated with a significantly lower rate of hernia recurrence than simple suture repair in adults.
The laparoscopic technique is a minimally invasive option requiring general anesthesia and three or fewer small incisions, or ports, placed away from the hernia site. Carbon dioxide gas is introduced into the abdomen to inflate the space, creating a working area for the surgeon. A laparoscope, a thin tube with a camera, is inserted through one port to provide a magnified view on a monitor.
Surgical instruments are inserted through the other ports to manipulate the tissues and reduce the hernia sac contents. The surgeon then places a specialized mesh, often a composite material, over the defect. This mesh is secured with tacks, staples, or specialized sutures, a technique known as Intraperitoneal Onlay Mesh (IPOM). The small incisions are closed with sutures or surgical glue, resulting in reduced scarring and a quicker recovery compared to the open approach.
Recovery and Post-Operative Expectations
Immediately following the procedure, patients are monitored in a recovery area while the effects of anesthesia wear off. Initial pain management is initiated, often including the injection of a long-acting local anesthetic directly into the incision sites. Patients are typically discharged the same day with prescriptions for oral pain medication, which may include a combination of non-opioids and narcotics.
Wound care instructions depend on the type of closure used. If surgical glue or waterproof dressings are applied, showering is usually permitted within 24 to 48 hours, but baths should be avoided for several weeks. Patients must avoid lifting anything heavier than ten to twenty pounds for four to six weeks to prevent strain on the repaired abdominal wall. Light activity, such as walking, is encouraged immediately to promote circulation and aid recovery.
Patients and caregivers are instructed to watch for specific signs that may indicate a complication requiring immediate medical attention. Swelling and bruising are common and expected, but a firm, painful, and irreducible bulge near the repair site could indicate a recurrence. Warning signs include:
- A persistent fever greater than 101 degrees Fahrenheit.
- Increasing pain that is not controlled by prescribed medication.
- Significant bleeding or excessive drainage from the incision site.
- Spreading redness or warmth around the wound, which can signal an infection.
- Difficulty passing urine or stool.