An umbilical hernia represents a tissue bulge that forms on or near the belly button, or umbilicus, when a portion of the intestine, fat, or abdominal lining pushes through a weak spot in the abdominal wall muscle. This weakness is a defect in the fascial tissue that normally surrounds and contains the abdominal contents. While many umbilical hernias in infants close naturally, those in adults typically persist and require surgical intervention to prevent complications like incarceration or strangulation. The process of surgical repair, known as a hernioplasty, involves a precise sequence of steps designed to return the protruding tissue to the abdominal cavity and strengthen the muscle wall defect.
Preparing for the Procedure
The preparation for umbilical hernia repair begins with a review of the patient’s overall health. Pre-operative assessments, such as blood work, an electrocardiogram (EKG), and a chest X-ray, may be ordered depending on the patient’s age and existing medical conditions. Patients are instructed to stop eating and drinking after midnight on the day of the procedure to prevent complications related to aspiration during anesthesia.
The surgical team also manages current medications, as blood-thinning agents like aspirin must often be temporarily discontinued prior to minimize bleeding risk. The procedure is typically performed under general anesthesia, which ensures the patient is asleep and pain-free. For smaller, open repairs, a local or regional anesthetic combined with sedation may sometimes be used instead.
Core Steps of Umbilical Hernia Repair
The surgical repair begins with a small incision made in the skin fold just below the navel, often curvilinear to help conceal the scar. The surgeon then dissects through the tissue layers until the hernia sac is identified and isolated. This sac is a pouch of abdominal lining containing the protruding tissue, such as fatty tissue (omentum) or a loop of the small intestine.
The next step is the reduction of the contents, where the surgeon gently pushes the material back into the abdominal cavity. Once reduced, the empty hernia sac may be tied off and removed, or simply inverted. The final step involves closing the defect in the fascial layer of the abdominal wall. This is accomplished by bringing the edges of the surrounding muscle tissue together and securing them with non-absorbable sutures to restore the wall’s integrity.
Choosing the Right Surgical Technique
The specific surgical method is determined by the size of the defect and whether the patient is an adult or a child. Traditional open repair, involving a single incision near the navel, remains common for small defects, typically less than two centimeters in diameter. For larger, recurrent hernias, or for patients with obesity, a minimally invasive laparoscopic approach is often selected.
Laparoscopic repair involves several small incisions through which a camera and specialized instruments are inserted. A primary consideration is the choice between primary closure with sutures and the placement of surgical mesh. For adult hernias larger than one to two centimeters, mesh placement is routinely recommended because it lowers the recurrence rate compared to simple suture repair, providing tension-free reinforcement over the muscle defect.
Immediate Post-Surgery Expectations
Following the repair, the patient is moved to the Post-Anesthesia Care Unit (PACU) to recover from the anesthesia and be monitored closely. During this immediate recovery phase, nurses track the patient’s vital signs to ensure stability as the anesthetic effects wear off. Pain management is a priority, and patients commonly receive medication to control discomfort around the surgical site.
Most umbilical hernia repairs are performed as outpatient procedures, allowing the patient to be discharged home on the same day. Discharge criteria require the patient to be fully awake, able to ambulate safely, and capable of tolerating fluids and food. Patients are instructed on wound care and provided with a prescription for pain relievers to manage the expected soreness during recovery.