What is the management of umbilical (navel) hernia?

From the Guidelines

Umbilical hernias should be managed based on a discussion with the patient and a multidisciplinary team involving physicians, surgeons, and anaesthetists to determine the suitability and timing of surgical repair. This approach is recommended due to the complexity of the condition and the need for individualized care 1. The management of umbilical hernias should consider the size, symptoms, and patient factors, with small asymptomatic hernias (less than 1-2 cm) in adults potentially being observed, while symptomatic hernias, those larger than 2 cm, or hernias that don't resolve spontaneously in children by age 4-5 may require surgical repair.

Key Considerations

• The standard treatment for umbilical hernias is surgical repair, which can be performed as an open procedure or laparoscopically 1.
• For patients with cirrhosis and ascites, the management of umbilical hernias should take into account the increased abdominal pressure and the risk of complications such as incarceration, pressure necrosis, rupture, evisceration, and peritonitis 1.
• The use of prosthetic mesh may reduce the recurrence rate but may increase the risk of infections and other complications 1.
• Postoperative care should include control of ascites and optimization of nutrition to ensure a successful outcome 1.

Surgical Repair

• The surgical repair of umbilical hernias involves making a small incision at the umbilicus, identifying and reducing the hernia sac, and closing the fascial defect with non-absorbable sutures or mesh reinforcement for larger defects (typically >2-3 cm) 1.
• Mesh options include polypropylene, polyester, or biologic materials.
• Post-operative care includes pain management with acetaminophen or NSAIDs, activity restriction for 2-4 weeks (no heavy lifting >10-15 pounds), and wound care.

Complications

• Complications to monitor include infection, recurrence, and mesh-related issues.
• Surgical repair is effective because it addresses the underlying anatomical defect by closing the fascial opening through which abdominal contents protrude, restoring normal anatomy and preventing potential complications like incarceration or strangulation of bowel.

From the Research

Umbilical Hernia Management Overview

• Umbilical hernias are common and surgery is often indicated in symptomatic patients 2
• The choice of treatment depends on the size and complexity of the hernia, with options including open, laparoscopic, and robotic repair 2

Treatment Options

• Mesh repair is generally recommended, as it has been shown to decrease recurrence rates, even in small hernias 2, 3, 4
• Suture repair may be considered for small hernia defects of less than 1 cm 3, 4
• Laparoscopic-assisted, open umbilical hernia repair is a viable option, with favorable outcomes and low recurrence rates 5

Mesh Repair

• The use of a non-absorbable (permanent) flat mesh in the preperitoneal space with an overlap of the hernia defect of 3 cm is recommended 3
• Onlay mesh repair can be considered comparable to suture repair and is safe to use for smaller umbilical hernias 6
• The superiority of mesh repair is evident for epigastric/primary umbilical hernias with a defect larger than 1 cm 4

Complications and Outcomes

• Postoperative complications, such as wound erythema, hematomas, and seromas, can occur, but are generally rare 5
• Recurrence rates are generally low, but can be higher in certain cases, such as those with larger hernia defects or previous failed repairs 2, 3, 5
• Chronic pain and other long-term complications can occur, but are relatively rare 2, 5