How to reduce an umbilical (navel) hernia?

From the Guidelines

To reduce an umbilical hernia, lie on your back with your knees bent and try to gently push the protruding tissue back into the abdomen using your fingertips, applying gentle, steady pressure toward the abdomen without forcing it if you feel resistance or pain, as recommended by general medical guidelines 1. This technique, called manual reduction, works best when you're relaxed and the hernia is small.

Key Considerations

• For infants with umbilical hernias, reduction is rarely necessary as most resolve naturally by age 4-5 1.
• If the hernia is painful, hard, discolored, or cannot be reduced, seek immediate medical attention as this may indicate incarceration or strangulation, which are medical emergencies 1.

Management and Prevention

• While manual reduction can temporarily relieve symptoms, it doesn't fix the underlying abdominal wall defect 1.
• The only permanent treatment is surgical repair, which is recommended for adults with symptomatic hernias or those that don't resolve in children after age 4-5 1.
• Until surgery, avoid heavy lifting and straining, maintain a healthy weight, and consider using an abdominal binder for temporary support if recommended by your doctor 1.

Special Considerations for Patients with Ascites

• In patients with cirrhosis and ascites, umbilical hernias can be more prone to complications such as incarceration, strangulation, and rupture 1.
• Optimal fluid control, appropriate nutrition, and conservative management with binders may minimize or prevent hernia development and progression 1.
• Surgical repair may be considered in select patients after careful consideration of its risks and benefits, with a possible need for an emergent operation 1.

From the Research

Reducing an Umbilical Hernia

To reduce an umbilical hernia, the following steps can be considered:

• Manual reduction (taxis) can be a feasible option, especially during times when emergency surgery capabilities are under strain, such as the COVID-19 pandemic 2.
• The use of a visual analogue scale (VAS) score can be an adjuvant tool for monitoring the success of manual reduction 2.
• Patients with successful manual reduction and low VAS score can be hospitalized for a 24-hour period of observation and then scheduled for an elective hernia repair 2.

Factors to Consider

When considering reducing an umbilical hernia, the following factors should be taken into account:

• The size of the hernia: smaller hernias (< 1 cm) may be more suitable for suture repair, while larger hernias may require mesh repair 3, 4.
• The patient's age, sex, and BMI: these factors may influence the choice of surgical technique and the use of mesh 4.
• The presence of comorbidities: such as diabetes mellitus, which may affect the patient's overall health and surgical outcomes 4.

Surgical Techniques

The following surgical techniques can be used to reduce an umbilical hernia:

• Open repair: this is a common approach for umbilical hernia repair, but it may have a higher risk of complications and recurrence 3, 4.
• Laparoscopic repair: this is a minimally invasive approach that may have a lower risk of complications and recurrence, but it may not be suitable for all patients 3.
• Robotic repair: this is a newer approach that may offer improved precision and dexterity, but it may not be widely available 3.
• Mesh repair: this is a common technique used to reinforce the hernia defect and reduce the risk of recurrence 3, 4, 5.