From the Guidelines
Surgical repair is the recommended treatment for umbilical hernia, especially in adults or symptomatic cases, as it prevents complications such as incarceration or strangulation. The decision for surgical repair should be made in discussion with the patient and a multidisciplinary team involving physicians, surgeons, and anaesthetists 1, 2. For infants and children, observation is typically recommended unless complications occur, as most umbilical hernias close spontaneously by age 4-5 years.
Key Considerations for Surgical Repair
- The procedure may involve open repair or laparoscopic techniques, with the use of sutures alone for small hernias or mesh reinforcement for larger defects to prevent recurrence.
- The use of mesh in clean surgical fields is associated with a lower recurrence rate without an increase in wound infection rate 3, 4.
- Pain management after surgery typically includes acetaminophen or ibuprofen for 3-5 days, and patients should avoid heavy lifting for 4-6 weeks post-surgery to allow proper healing.
Special Considerations
- In cases of intestinal strangulation or concurrent bowel resection, emergent prosthetic repair with synthetic mesh can be performed without an increase in 30-day wound-related morbidity 3.
- For stable patients with strangulated hernia and bowel necrosis, primary repair is recommended when the size of the defect is small, or a biological mesh may be used for repair if direct suture is not feasible 3.
Post-Surgical Care
- Patients should be monitored for signs of complications such as infection, bleeding, or recurrence.
- Follow-up appointments should be scheduled to assess the healing process and remove any sutures or staples.
Overall, the goal of treatment for umbilical hernia is to prevent complications, alleviate symptoms, and improve quality of life, with surgical repair being the standard treatment for adults or symptomatic cases.
From the Research
Treatment Options for Umbilical Hernia
The treatment for umbilical hernia can vary depending on the size of the hernia and the patient's overall health.
- For small hernias (< 1 cm), suture repair may be considered, as it is a less invasive procedure 5, 6.
- For larger hernias (> 1 cm), the use of a non-absorbable mesh is generally recommended, as it has been shown to decrease recurrence rates 7, 6.
- The approach to repair can be either open or laparoscopic, with each having its advantages and disadvantages 7, 8.
Surgical Techniques
Different surgical techniques can be used to repair an umbilical hernia, including:
- Open repair: This involves making a small incision in the abdomen to access the hernia and repair it with a mesh or suture 5, 8.
- Laparoscopic repair: This is a minimally invasive procedure that uses a laparoscope to visualize the hernia and repair it with a mesh or suture 7, 8.
- Laparoscopic-assisted open repair: This is a combination of open and laparoscopic techniques, where a small incision is made to access the hernia and a laparoscope is used to visualize the repair 8.
Use of Mesh
The use of mesh in umbilical hernia repair is a topic of debate, particularly for small hernias.
- Some studies suggest that mesh should be used for all hernias, regardless of size, as it decreases recurrence rates 7, 6.
- Others suggest that suture repair is sufficient for small hernias (< 1 cm) and that mesh is not necessary 5, 6.
- However, the majority of studies agree that mesh is beneficial for larger hernias (> 1 cm) and that it should be used to reduce recurrence rates 7, 6.
Patient Factors
Patient factors, such as age, sex, and body mass index (BMI), can influence the choice of surgical technique and the use of mesh.