An umbilical hernia occurs when tissue, such as intestine or fatty tissue, bulges through a weakness in the abdominal wall near the navel (umbilicus). This protrusion happens through the opening that once housed the umbilical cord during fetal development. While generally harmless, a hernia can cause discomfort and, in rare cases, serious complications if the protruding tissue becomes trapped. The approach to repair varies depending on the patient’s age, the size of the defect, and whether the hernia is causing symptoms.
Differentiating Observation from Intervention
The decision to observe an umbilical hernia or proceed with surgical intervention largely depends on whether the patient is a child or an adult. In infants and young children, the abdominal wall defect often closes on its own without any treatment. Most umbilical hernias in babies, especially those present at birth, naturally resolve by the time the child reaches four or five years of age. Observation is the standard approach for small, asymptomatic hernias in children, as early surgery may carry a higher risk of complications.
Intervention becomes necessary if the hernia causes pain, is especially large (greater than one to two centimeters in diameter), or persists past the age of five. The primary reason for urgent intervention is strangulation, where the blood supply to the trapped tissue is cut off, requiring immediate medical repair.
Adult umbilical hernias rarely resolve spontaneously and usually require surgical repair to prevent complications. Increased abdominal pressure, often caused by obesity or multiple pregnancies, makes natural closure unlikely. Surgery is recommended for adults to avoid the risk of the hernia enlarging, causing pain, or leading to acute complications like incarceration or strangulation.
Surgical Repair Techniques
When surgery is needed, the procedure pushes the bulging tissue back into the abdominal cavity and closes or reinforces the abdominal wall defect. Surgeons choose between primary suture repair or mesh repair, both performed using open or laparoscopic techniques. The choice depends on the defect size and the patient’s overall health.
Primary Suture Repair (Herniorrhaphy)
Primary suture repair, or herniorrhaphy, involves stitching the edges of the muscle defect together. This method is often preferred for very small hernias, particularly in children, where the surrounding tissue is strong enough to hold the closure. However, for adult hernias, especially those larger than one to two centimeters, using only sutures is associated with a significantly higher risk of the hernia returning.
Mesh Repair (Hernioplasty)
For larger defects or in most adult patients, mesh repair, or hernioplasty, is the preferred approach to reduce the chance of recurrence. This technique involves placing a synthetic or biologic mesh over or under the defect to act as a scaffold, reinforcing the abdominal wall. Mesh repair significantly lowers the long-term recurrence rate compared to suture-only closure.
Open vs. Laparoscopic Techniques
The surgical approach can be open or laparoscopic, which is a minimally invasive technique. An open repair involves a small incision, often curved around the navel, through which the surgeon directly accesses the hernia sac. Laparoscopic repair uses several small incisions away from the navel, through which specialized instruments and a camera are inserted to repair the defect from the inside. Laparoscopic methods are associated with less scarring and potentially a quicker recovery. Open repair is often favored for smaller hernias due to its simplicity and the ability to hide the incision within the navel’s folds.
Post-Procedure Care and Long-Term Outlook
Following umbilical hernia repair, immediate post-procedure care focuses on managing discomfort and monitoring the incision site. Most umbilical hernia repairs are performed as outpatient procedures, meaning the patient typically goes home the same day. Pain is managed with nonsteroidal anti-inflammatory medications, though some patients may feel a temporary tightness in the abdomen where the muscle was repaired.
The most important aspect of recovery is adhering to activity restrictions to allow the repaired abdominal wall to heal fully. Patients are typically advised to avoid heavy lifting, strenuous exercise, and any activity that causes strain on the abdomen for several weeks. Preventing strain, such as avoiding constipation or excessive coughing, is crucial to minimize pressure on the surgical site during the initial healing period.
The long-term outlook after a successful repair is generally favorable, but there is always a low risk of the hernia recurring. The recurrence rate is significantly lower when mesh is used for reinforcement, particularly for adult hernias. Signs to watch for include a return of the bulge near the navel, increasing pain, or any signs of infection at the incision site.