Umbilical hernia
What is an umbilical hernia?
An umbilical hernia is a type of abdominal hernia, where contents of the abdominal cavity are displaced upward around the navel through a weakness or malformation of the abdominal muscles. The resulting bulge is called the hernial sac. This type of hernia is most common in newborns and is a result of the umbilical ring failing to close properly after birth. However, umbilical hernias also appear in pregnant women as a result of the fetus applying outward pressure on the abdominal wall muscles. This hernia can also appear in adults due to age-related weakness in the abdominal muscles.
Umbilical Hernia – Symptoms
In infants, the most common symptom is a bulge near the navel. This is typically normal and usually disappears spontaneously around 12 months after birth as abdominal muscles strengthen. Adults, however, often struggle with a paraumbilical hernia, which is accompanied by slight pain or general feelings of discomfort in the area. Umbilical hernias are usually mild. However, more severe symptoms appear only when the abdominal contents inside the hernia become trapped, or “strangulated.” If left untreated, strangulated hernias carry a risk of death. If a red, painful protrusion occurs around the navel and symptoms such as vomiting, fever, and excessive flatulence appear, then urgent surgical consultation and treatment are necessary. It is critical to reiterate that failure to seek surgical intervention in the event of hernia strangulation may result in complete intestinal obstruction and necrosis, which may lead to death.
Umbilical Hernia – Causes
In infants, an umbilical hernia is an anatomical defect that results from the non-fusion of the umbilical ring, i.e. the opening through which the vessels from the umbilical cord enter the fetus during development. In adults, umbilical hernias are usually associated with a weakening in the abdominal wall muscles with age. The causes of umbilical hernia in adults are:
- Pregnancy, due to increased intraabdominal pressure caused by the fetus
- Obesity
- Ascites, or fluid retention in the abdomen
- Heavy lifting or physical exertion
- Chronic cough
- Constipation
- Prostate diseases that are associated with straining during urination
- Certain gastrointestinal diseases.
Umbilical Hernia – Treatment
In young children, umbilical hernias often close spontaneously. However, should they not close by 12 months, hernia repair surgery is typically indicated. In adult patients with new, small, asymptomatic umbilical hernias, periodic check-ups suffice. The decision to proceed with surgery is based on the severity of symptoms or if the hernia grows, thus increasing the risk for strangulation of herniated abdominal contents. Surgical repair involves a technique called hernioplasty and can be done via open or minimally invasive techniques utilizing laparoscopic or robotic surgical approaches. The procedure is performed under general anesthesia, and depending on the size of the hernia, may last between 30 minutes and 1.5 hours. The operation involves replacing all abdominal contents into their correct anatomical position, then suturing the defect closed using abdominal muscles and/or artificial mesh to support the abdominal wall if the defect is large. This minimizes the risk of hernia recurrence by strengthening the incision site.
Umbilical Hernia – Contraindications to Surgery
Contraindications to surgical umbilical hernia repair include active inflammation of the skin or subcutaneous tissue, along with other concurrent inflammatory diseases. A detailed medical interview and physical exam before the procedure is required in patients taking anticoagulants, as well as those with ischemic heart disease, hypertension, heart failure, anemia, and electrolyte disturbances.
Umbilical Hernia – Robotic Surgery
Robotic umbilical hernia repair is done under general anesthesia and utilizes a few one-centimeter incisions in the abdomen that heal with little to no visible scarring. These small incisions serve as doors for the camera and all specialized surgical tools. After precisely localizing the hernia, surgeons return the abdominal contents into their correct anatomical position then suture closed the opening using existing muscles and, if indicated, an artificial mesh to strengthen the site and reduce the risk of recurrence. Unlike open or laparoscopic surgery, the surgeon is not directly at the patient’s table, but rather controls the robotic instruments through a dedicated console in a comfortable seated position to avoid fatigue. Robotic surgery enables surgeons to operate at high magnification, which facilitates the accurate detection of nerves and blood vessels. Additionally, the robotic arms are more dexterous than the human hand, enabling surgeons to place sutures or dissect tissues with extreme precision. Robotic surgery benefits patients in many ways, namely less invasiveness, less postoperative pain, and a lower risk of complications such as infection and blood loss. Robotic surgery also shortens the duration of a procedure, lowering the risk of anesthesia-related complications, and ultimately decreasing the length of stay in hospital. Additionally, it allows patients with obesity to undergo minimally invasive bariatric surgery.
It is now possible to operate large, recurrent umbilical hernias thanks to advances in robotic surgical technology. Traditionally, the use of laparoscopy in cases of large hernias, e.g., resulting from pregnancy, was highly challenging and sometimes even impossible. In recent years, however, groundbreaking purely robotic techniques have been developed for patients with this type of hernia. We perform these novel hernia treatments at The European Center for Comprehensive Hernia Treatment in collaboration with the best European and American clinics to ensure the highest standard of patient care.
Umbilical Hernia – Recovery
Hospitalization after umbilical hernia repair surgery depends on the extent of the procedure and method used, however, one can expect to remain hospitalized for about 1-3 days. Anticoagulants are contraindicated in the first days after surgery, and you should avoid physical activity, especially lifting heavy objects for at least the first month after surgery. It is also advisable to begin a special exercise regimen 4 weeks following surgery to strengthen abdominal muscles, details of which will be provided by your Individual Patient Counselor.
Umbilical Hernia – Price
The price of an umbilical hernia repair depends on the stage of disease, the type of mesh used to reinforce the abdominal wall, and whether it is done classically, laparoscopically, or robotically. All details of the operation and possible treatment options are always discussed together with the attending physician during the initial consultation where you are qualified for the procedure.
