Lewis Gale Physicians July 24, 2018

An abdominal hernia is soft tissue that has pushed through the abdominal wall after the abdominal wall weakens, bulges, or tears. An umbilical hernia is an abdominal hernia near the belly button that occurs when muscles do not completely close around the hole left by the umbilical cord. They are common in newborns, but also can occur in adults. 

The inner lining of the abdomen and small intestine can poke out of this weakened area. A hernia repair is a surgery to push the abdominal material back where it belongs and to repair the abdominal wall.

Causes of Umbilical Hernia

During pregnancy, the umbilical cord passes from the mother to the baby through a small opening in the baby’s abdomen. A weakness in the abdomen occurs when the muscles of the baby’s abdomen do not completely close after birth. The weakness can cause abdominal tissue to push through the belly button.

In addition, adults can have umbilical hernias that are caused by: 

  • Chronic coughing
  • Obesity
  • Fluid in the belly due to cirrhosis of the liver
  • Multiple pregnancies 

Risk Factors for Developing Umbilical Hernia

A risk factor is something that increases the chance of developing a particular condition. Risk factors that heighten the chance for umbilical hernia include: 

  • Being of African-American descent
  • Genetics (family history of umbilical hernia)
  • Premature birth
  • Birth weight under 3.5 pounds (1,500 grams)
     

Preventing Umbilical Hernias

There are no current guidelines to prevent an umbilical hernia.
 

Diagnosing Umbilical Hernia

You will be asked about your or your baby's symptoms and medical history, and a physical exam will be done. An umbilical hernia can be diagnosed during the physical exam.
 

Reasons for Having a Hernia Repair Procedure

In most children, an umbilical hernia appears as a protrusion in the naval area. It often goes away on its own without any treatment by the time the child is 3 to 4 years of age. You and your doctor will watch the hernia to ensure that new problems do not develop. Surgical repair may be necessary for children, especially those over the age of 5, or for adults. For example:

  • Large or painful hernias will not resolve without treatment and often require surgery to place dislocated tissue back in place and close the damaged abdominal wall.
  • Rarely, a loop of intestine becomes trapped in the abdominal wall. This may lead to a blockage of the intestine.
  • Strangulation can also occur if the hernia is slowing or blocking blood flow. Strangulated hernias are a medical emergency and can be life-threatening if part of the bulging tissue becomes trapped and circulation is cut off to the tissue. 

If left unattended, the protrusion through the hole or gap may cause increasing amounts of pain as more abdominal tissue pushes through the gap. As long as the hernia is reducible, it is not considered dangerous, but it can still put pressure on the surrounding tissue. Without surgery, the hernia will not heal, and the pain and size of the hernia usually increases over time.
 

What to Expect From Your Hernia Repair Surgery

Hernia repair surgery may be performed either as conventional open surgery or as a less invasive laparoscopic procedure. 

Prior to the Procedure

Before your or your child’s hernia repair procedure, your doctor may do the following: 

  • Physical exam
  • Blood tests
  • Urine tests
  • Electrocardiogram (EKG)—A test measures the electrical activity of the heart.
  • Talk to you about your medications. You may be asked to stop taking some medications up to 1 week before the procedure. 

On the days before and the day of your procedure, your doctor may recommend that you: 

  • Follow a special diet.
  • Take antibiotics.
  • Shower the night before, using antibacterial soap.
  • Arrange for someone to drive you home and to help you at home.
  • Eat a light meal the night before surgery. Do not eat or drink anything after midnight.
  • Wear comfortable clothing. 

Anesthesia

Anesthesia will prevent any pain during surgery. Depending on the type of hernia repair, you may receive: 

  • Local anesthesia—the area will be numbed
  • General anesthesia—you will be asleep during the procedure 

Description of the Hernia Repair Procedure

Hernia repair surgery usually takes less than 2 hours and there are 2 main types of surgery: 

  1. Conventional Surgery
    Conventional surgery uses a large incision so that the doctor can directly access the area. An incision is made over the hernia site and the hernia is moved back into the abdominal cavity, or the hernia sac may be removed altogether. In the case of hiatal hernia, the stomach is moved from the chest cavity back down to the abdominal cavity. For some, the weakened muscles that allowed the hernia to develop are sewn together. If the weakened area is large or in the groin, a piece of mesh will be placed over the area to create a new wall. If mesh is used, the muscle is not sewn together. The incision will be closed with stitches or staples.

 

  1. Laparoscopic Surgery
    Laparoscopic surgery uses smaller incisions and special surgical tools. Small incisions are made around the hernia and special surgical tools are placed through these incisions. A small camera is passed through an incision so that the doctor can see inside the abdomen. Other small instruments will be used to complete the repair. After the procedure, the incisions are closed with stitches or staples and a sterile dressing is applied. 

You and your doctor will discuss the risks and benefits of each surgery to determine which may be best for you. Factors like your overall health, location of hernia, and complications will play a role in the decision.

 

Immediately After the Procedure

You or your child will be taken to a recovery area. Fluids and pain medications will be delivered through an IV. If there are no problems, you will be moved to a hospital room to recover.

 

Post-procedure Care

At home, slowly return to normal activities and diet. You will have to restrict activities during your recovery. This includes no straining or heavy lifting until your doctor says it is okay to do so. Follow wound care instructions to avoid infection. Your doctor may advise medication if you experience and pain or discomfort. The recovery time is shorter for patients who have laparoscopic surgery. 

There is some risk that the hernia could return. To reduce your risk: 

  • Maintain a healthy weight.
  • Eat a healthful diet.
  • Strengthen your abdominal muscles.
  • Treat chronic constipation, allergies, or chronic cough.

 

Potential Complications from Hernia Repair

Complications are rare, but no procedure is completely free of risk. If you are planning to have a hernia repair, your doctor will review a list of possible complications, which may include: 

  • Damage to neighboring organs or structures (such as the intestines or bladder)
  • Infection
  • Bleeding
  • Scarring
  • Reaction to anesthesia
  • Chronic pain from nerve damage 

Factors that may increase the risk of complications include: 

  • Having neurological, heart, or lung conditions
  • Age: older than 70 years
  • Obesity
  • Smoking
  • Active infection
     

When To Call Your Doctor

Call your doctor if your recovery is not progressing as expected or you develop complications, including: 

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persistent nausea and/or vomiting
  • Pain that you cannot control with the medications you were given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Excessive tenderness or swelling
  • Cough, shortness of breath, or chest pain 

If you think you have an emergency, call for medical help right away. For questions or concerns regarding hernias, Dr. Amanda Reese is welcoming new patients. To schedule an appointment, please call the office at (540) 552-0005.