From the Guidelines
Surgical repair is the recommended treatment for umbilical hernias in adults, especially when symptomatic, to prevent complications such as incarceration or strangulation. The decision to operate should consider the patient's overall health, the size of the hernia, and the presence of symptoms 1. For patients with cirrhosis and ascites, elective herniorrhaphy may be offered in select cases after careful consideration of its risks and benefits, with the preference for laparoscopic approaches 1.
Key considerations in the management of umbilical hernias include:
- Controlling ascites before elective surgery to minimize complications 1
- Optimizing nutrition postoperatively for a successful outcome 1
- The use of prosthetic mesh to reduce recurrence rates, although it may increase the risk of infections and other complications 1
- Avoiding heavy lifting and managing pain appropriately post-surgery
In patients who are candidates for liver transplantation (LT) in the near future, hernia repair should be deferred until during or after transplantation 1. For those not imminent for LT, a careful assessment of the risks and benefits of surgical versus nonoperative management is necessary 1.
From the Research
Umbilical Hernia Treatment
The recommended treatment for an umbilical hernia depends on various factors, including the size of the hernia, symptoms, and patient's overall health.
- Surgery is often indicated for symptomatic patients, with options including open, laparoscopic, and robotic repair 2.
- The use of mesh in umbilical hernia repair is generally recommended, as it has been shown to decrease recurrence rates, even in small hernias 2, 3, 4.
- For small umbilical hernias (< 2 cm), suture repair may be considered, but mesh repair is still recommended due to lower recurrence rates 3, 4.
Surgical Techniques
Different surgical techniques can be used for umbilical hernia repair, including:
- Open repair: a traditional approach that involves making an incision in the abdomen to repair the hernia 2.
- Laparoscopic repair: a minimally invasive approach that uses small incisions and a camera to repair the hernia 2.
- Robotic repair: a newer approach that uses robotic technology to assist with the repair 2.
- T-line hernia mesh repair: a newer technique that uses a synthetic mesh to prevent anchor point failure and reduce recurrence rates 5.
Special Considerations
In certain situations, special considerations must be taken into account when treating an umbilical hernia, such as:
- Pregnancy: umbilical hernia repair can be performed during pregnancy, but the timing of surgery depends on the individual case 6.
- Obesity: obese patients may require special consideration when undergoing umbilical hernia repair, including the use of larger mesh sizes 5.
- Recurrence: patients who have experienced a previous hernia recurrence may require mesh repair to reduce the risk of further recurrence 5, 4.