From the Guidelines
Umbilical hernias should be treated with prosthetic repair, which is the treatment of choice for most abdominal wall complicated hernias, including umbilical hernias, as it provides the best outcomes in terms of morbidity, mortality, and quality of life. An umbilical hernia occurs when part of the intestine or abdominal tissue pushes through a weakness in the abdominal muscles around the navel (belly button), creating a visible bulge, especially when the person coughs, strains, or cries. Treatment depends on the size of the hernia and whether it causes symptoms. In children under 4-5 years old, most umbilical hernias close naturally without intervention, so doctors typically recommend watchful waiting 1. For adults or children with hernias that don't close on their own, surgical repair is the standard treatment. The procedure, called an umbilical herniorrhaphy, involves pushing the protruding tissue back into place and strengthening the abdominal wall, often using mesh for larger hernias.
Key Points to Consider
- Surgery is usually performed as an outpatient procedure under general anesthesia and takes about 30-60 minutes 1.
- Recovery typically requires limiting strenuous activity for 4-6 weeks.
- Surgery becomes urgent if the hernia becomes incarcerated (trapped) or strangulated (blood supply cut off), which causes severe pain, vomiting, and requires emergency intervention.
- Patients should seek immediate medical attention if the hernia becomes hard, painful, or changes color, as these are signs of potential complications.
- The use of prosthetic mesh may reduce the recurrence rate but may increase the risk of infections and other complications 1.
- Postoperatively, control of ascites and optimization of nutrition are the key determinants of successful outcome, particularly in patients with cirrhosis and ascites 1.
From the Research
Definition of Umbilical Hernia
- An umbilical hernia occurs when part of the intestine or other tissue bulges through an opening in the abdominal wall near the navel [ 2 ].
Treatment Options
- Surgery is indicated in symptomatic patients [ 2 ].
- Treatment options include open, laparoscopic, and robotic repair [ 2 ].
- Each approach has its advantages and disadvantages [ 2 ].
Repair Techniques
- Mesh should be used for repair, as it has been shown to decrease recurrence rates, even in small hernias [ 2 ].
- The size of the hernia defect can range from small (<1 cm) to very large/complex hernias, and treatment options should be tailored to the clinical situation [ 2 ].