From the Guidelines
Not all umbilical hernias require referral to general surgery. The decision for surgical repair should be made in discussion with the patient and a multidisciplinary team involving physicians, surgeons, and anaesthetists, considering the suitability and timing of the repair 1.
Key Considerations
- The size of the hernia, with smaller hernias (less than 1-2 cm) potentially being monitored by primary care providers
- The presence of symptoms, such as pain or discomfort, which may necessitate referral to general surgery
- The reducibility of the hernia, with irreducible hernias requiring surgical evaluation
- The risk of complications, such as incarceration or strangulation, which necessitate urgent surgical referral
Patient-Specific Factors
- Adult patients with asymptomatic, small, and easily reducible hernias may not require immediate surgical referral
- Children with umbilical hernias that persist beyond age 4-5 years, are larger than 1.5-2 cm, or become symptomatic should be referred to general surgery
- Patients with umbilical hernias should be advised to avoid heavy lifting and straining to prevent worsening of the hernia 1.
Surgical Management
- The decision for surgical management depends on individual risk factors, hernia characteristics, and the presence of complications
- Untreated complicated hernias can lead to severe consequences, such as bowel obstruction or tissue death, requiring emergency surgery 1.
From the Research
Umbilical Hernia Referral to General Surgery
- Not all umbilical hernias require immediate referral to general surgery, as some may close spontaneously without intervention 2, 3.
- The decision to refer a patient with an umbilical hernia to general surgery depends on various factors, including the patient's age, symptoms, and the size of the hernia defect 4, 5.
- For uncomplicated pediatric umbilical hernias, watchful waiting until the age of 4 years is recommended, and referral to a pediatric surgeon is advised if the hernia fails to close beyond this age 2.
- For symptomatic umbilical hernias, repair is indicated, and the use of mesh is recommended to reduce the recurrence rate 4, 5.
- The approach to repair, whether open, laparoscopic, or robotic, depends on the clinical situation and the patient's individual needs 4, 6.
Special Considerations
- Incarceration or strangulation of an umbilical hernia is a rare but serious complication that requires prompt surgical intervention 3, 6.
- Obese patients or those with large hernia defects may benefit from a laparoscopic approach to reduce the risk of wound morbidity 5, 6.
- The use of a preperitoneal flat mesh is recommended for open repair of umbilical and epigastric hernias to reduce the recurrence rate 5.