What is the rate of growth of an umbilical hernia?

Rate of Growth of Umbilical Hernia

There is no standardized rate of growth for umbilical hernias, but hernias with a Hernia-Neck Ratio (HNR) greater than 2.5 are at significantly higher risk for complications and should be surgically repaired regardless of symptoms. 1

Growth Patterns and Risk Factors

Umbilical hernias vary considerably in their growth patterns, with several factors influencing progression:

• Hernia-Neck Ratio (HNR): This is a critical predictor of complications. When the ratio of hernia sac size to neck size exceeds 2.5, there is a 91% sensitivity and 84% specificity for predicting complications 1

  • Median hernia sac size in complicated hernias: 50mm (vs 30mm in uncomplicated)
  • Neck size remains relatively stable between complicated and uncomplicated hernias

• Size progression:

  • Small hernias (<1cm) may remain stable for years
  • Larger hernias tend to grow more rapidly, especially with contributing factors
  • Hernias ≥1.5cm in diameter are more prone to complications 2

• Contributing factors that accelerate growth:

  • Increased intra-abdominal pressure (obesity, pregnancy, ascites)
  • Heavy lifting (>10-15 pounds)
  • Cirrhosis with ascites (present in approximately 20% of these patients) 3
  • Poor nutrition status
  • Chronic cough

Complications Related to Growth

The risk of complications increases as umbilical hernias grow:

• Incarceration: More common when the hernia sac grows disproportionately to the neck
• Pressure necrosis: Risk increases with larger hernias
• Rupture and evisceration: Particularly concerning in rapidly growing hernias
• Peritonitis: Can develop after rupture or with infection

Management Based on Growth Rate

• Small hernias (<1cm):

  • May be managed conservatively if asymptomatic
  • Suture repair may be considered 4

• Medium hernias (1-2cm):

  • Despite guidelines recommending mesh repair, approximately 75% are still treated with suture repair 4
  • Higher recurrence rates with suture repair (1.8% vs 1.3%) 4

• Larger hernias (>2cm):

  • Mesh repair strongly recommended to reduce recurrence 5
  • Preperitoneal mesh placement with 3cm overlap is ideal but underutilized (only 1.8% of cases) 4

• Rapidly growing hernias:

  • Should be repaired promptly regardless of size
  • Particularly if HNR >2.5 1

Special Considerations

• Patients with cirrhosis and ascites:

  • Control of ascites is recommended before elective repair
  • Laparoscopic approaches preferred when ascites is present
  • Rapid decline in ascitic fluid can paradoxically cause incarceration 3

• Prevention of growth:

  • Avoid heavy lifting (>10-15 pounds)
  • Use proper body mechanics
  • Optimize nutrition status
  • Control underlying conditions that increase intra-abdominal pressure 3

Key Pitfalls to Avoid

• Underestimating small but symptomatic hernias: Even small hernias can develop complications if they have a high HNR
• Delaying repair of rapidly growing hernias: Growth rate, rather than absolute size, may be a more important indicator for surgical intervention
• Inadequate patient education: Patients should be informed about signs of complications and when to seek immediate medical attention
• Inappropriate surgical technique: Mesh repair is generally superior to suture repair for reducing recurrence rates, even in smaller hernias 5