From the Guidelines
Surgical repair is the recommended treatment for umbilical hernias in adults or when hernias are symptomatic, as it reduces the risk of incarceration or strangulation and improves quality of life. The decision to operate should be made in discussion with the patient and a multidisciplinary team involving physicians, surgeons, and anaesthetists 1.
Key Considerations
- For infants and children, watchful waiting is typically recommended as most umbilical hernias close spontaneously by age 4-5 years.
- In adults or when hernias are symptomatic, surgical repair is the standard treatment, which can be performed as open surgery or laparoscopically.
- Post-operative care includes pain management with acetaminophen or NSAIDs as directed, avoiding heavy lifting (typically >10 pounds) for 4-6 weeks, and gradually returning to normal activities.
- Patients with asymptomatic small hernias (<1-2 cm) may safely delay surgery unless complications develop.
Special Considerations
- In patients with cirrhosis and ascites, the management of umbilical hernia is more complex, and surgical repair should be considered on a case-by-case basis, taking into account the patient's overall health and the risk of postoperative complications 1.
- The use of prosthetic mesh may reduce the recurrence rate but may increase the risk of infections and other complications 1.
- Optimizing management of ascites, including large volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPSS) perioperatively, could reduce the risk of wound dehiscence and recurrence of hernia 1.
Evidence-Based Recommendations
- A recent retrospective series of 102 patients who underwent surgical repair of the umbilical hernia in the presence of ascites reported morbidity and mortality rates of 37.2% and 3.9%, respectively 1.
- Emergency surgery, Child-Pugh-Turcotte class C, American Society of Anaesthesiologists (ASA) score ≥3, and Model for End-Stage Liver Disease (MELD) score ≥20 are associated with increased mortality 1.
Conclusion Not Applicable
Instead, the key points to consider in the management of umbilical hernias are:
- Surgical repair is the recommended treatment for symptomatic umbilical hernias in adults.
- The decision to operate should be made on a case-by-case basis, taking into account the patient's overall health and the risk of postoperative complications.
- Optimizing management of ascites and using prosthetic mesh may reduce the risk of complications and recurrence.
From the Research
Umbilical Hernia Treatment
The recommended treatment for an umbilical hernia varies depending on the age of the patient and the size of the hernia.
- For asymptomatic umbilical hernias in children, conservative management until age 4-5 years is recommended, as most cases will close spontaneously during this time 2, 3.
- For children with umbilical hernias larger than 1 cm or those that persist beyond age 3-4, operative repair is recommended 3.
- In adults, mesh repair is recommended for umbilical hernias, as it has been shown to reduce recurrence rates compared to suture repair, even for smaller hernias (diameter 1-4 cm) 4.
- The choice of repair technique, such as open, laparoscopic, or robotic, should be tailored to the individual clinical situation, with mesh repair being the preferred method for most cases 5, 4.
Considerations for Treatment
- Spontaneous closure of umbilical hernias is unlikely to occur beyond the age of 5 years 2.
- Complications of operative repair, such as anesthesia-related complications and local wound infections, are possible but rare 3, 6.
- The use of mesh in repair has been shown to decrease recurrence rates and is recommended for most cases 6, 4.
- Chronic complaints, such as pain and recurrence, can occur after umbilical hernia repair, but are generally minimal with proper treatment 5, 6.