From the Guidelines
Surgical repair is the definitive treatment for periumbilical hernias, and early intervention is crucial to prevent complications and reduce morbidity and mortality rates. The diagnosis of periumbilical hernias involves a combination of clinical evaluation, laboratory tests, and imaging studies. Patients with suspected intestinal strangulation should undergo emergency hernia repair immediately, as the benefits of surgery outweigh the risks 1. The use of mesh for hernia repair in clean fields has been shown to have advantages, including low rates of long-term complications and reduction of recurrence 1.
Diagnosis
The diagnosis of periumbilical hernias can be challenging, and early detection of bowel strangulation is critical to prevent complications. Laboratory parameters such as lactate levels, CPK, and D-dimer can be useful in predicting bowel strangulation 1. Imaging studies, including CT scans, can also help diagnose bowel strangulation and guide treatment decisions.
Treatment
The treatment of periumbilical hernias depends on the size and symptoms of the hernia. Small, asymptomatic hernias may be monitored without immediate intervention, but surgery is recommended for hernias that are painful, growing, or at risk for complications. The surgical procedure involves pushing the protruding tissue back into place and repairing the abdominal wall defect, either through open surgery or laparoscopic techniques. Mesh hernioplasty has been shown to be safe and effective in preventing recurrence, with low rates of wound infection and recurrence 1.
Postoperative Care
Postoperative care for patients with periumbilical hernias includes pain management with acetaminophen or NSAIDs, such as ibuprofen (400-600mg every 6 hours as needed) for 3-5 days post-surgery. Patients should avoid heavy lifting (over 10 pounds) for 4-6 weeks after surgery to prevent recurrence. Complications are rare but can include infection, bleeding, recurrence, or damage to surrounding structures.
Risk Factors
Periumbilical hernias occur due to increased intra-abdominal pressure combined with weakness in the abdominal wall, often related to factors like obesity, pregnancy, chronic coughing, or previous abdominal surgeries. Early detection and treatment of periumbilical hernias are critical to preventing complications and reducing morbidity and mortality rates. The use of mesh for hernia repair in clean fields has been shown to have advantages, including low rates of long-term complications and reduction of recurrence 1.
- Key points to consider in the treatment of periumbilical hernias include:
- Early intervention to prevent complications and reduce morbidity and mortality rates
- Use of mesh for hernia repair in clean fields to reduce recurrence
- Postoperative care, including pain management and avoidance of heavy lifting
- Identification of risk factors, such as obesity, pregnancy, and previous abdominal surgeries, to guide treatment decisions.
From the Research
Diagnosis of Periumbilical Hernia
- A periumbilical hernia, also known as an umbilical hernia, is a type of hernia that occurs near the belly button 2, 3, 4, 5
- The diagnosis of a periumbilical hernia is typically made through a physical examination and medical history 4
- The size of the hernia defect can range from small (<1 cm) to large and complex, even in the absence of prior incision or repair 2
Treatment Options for Periumbilical Hernia
- Surgical repair is the most common treatment for periumbilical hernias, with options including open, laparoscopic, and robotic approaches 2, 3, 5
- Mesh placement is often used to decrease recurrence rates, and its use and location of placement should be individualized for each patient 2, 3, 4, 5
- The choice of treatment approach depends on various factors, including the size and complexity of the hernia, as well as the patient's overall health and medical history 6, 4
Surgical Techniques for Periumbilical Hernia Repair
- Laparoscopic extended view totally extraperitoneal repair (e-TEP) is a minimally invasive technique that has been shown to be effective for umbilical hernia repair 3
- The MILOS and EMILOS repair techniques are also used for primary umbilical and epigastric hernias, with low complication and recurrence rates 5
- Preoperative progressive pneumoperitoneum (PPP) can be used to increase the capacity of the abdominal cavity prior to hernia repair, allowing for better physiological postoperative adaptation 6
Postoperative Care and Complications
- Postoperative care for periumbilical hernia repair typically involves monitoring for complications such as seroma, hematoma, and surgical site infection 3, 4
- The use of local anesthesia and intravenous sedation can help to reduce postoperative pain and discomfort 4
- The risk of recurrence and chronic pain after periumbilical hernia repair is generally low, but can vary depending on the surgical technique and individual patient factors 2, 3, 5