Umbilical hernia
Umbilical hernia, also known as umbilical hernia, is a common gap in the umbilical region through which fat and, in large hernias, loops of intestine can bulge.
SUMMARIZED
- Umbilical hernias are common and most people have no problems with them except for the outward appearance.
- However, the size increases with age and so does the risk of entrapment (incarceration), which is about 6-8%.
- Therefore, it is recommended to have the umbilical hernia operated early even in case of mild symptoms.
- As a rule, the operation is performed on an outpatient basis under anesthesia.
- Mesh insertion is recommended from about 1cm and the surgery is usually performed through a small skin incision.
What is an umbilical hernia?
The navel is a natural weak point of our abdominal wall, which is why this type of hernia is very common.
As the child develops in the uterus, the blood vessels in the umbilical cord pass through the child's navel and ensure the supply of nutrients. After birth, the umbilical cord is cut and the umbilical ring closes.
This may be partially omitted or widening may occur, which is favored, for example, by muscle and connective tissue weakness, pregnancy or obesity.
The risk of an incarceration of fatty tissue or even intestine is about 6-8% in the course of life. Therefore, an umbilical hernia should always be operated on if it grows in size and causes discomfort.
How is an umbilical hernia diagnosed?
For experienced surgeons, a glance is enough for a diagnosis. When standing, a small bump appears in the umbilical region, which recedes when lying down and emerges again when pressing.
If the findings are unclear, an ultrasound examination (sonography) can be performed. In the case of very large umbilical hernias or before planning surgery, a computer tomography (CT) or magnetic resonance imaging (MRI) can also be performed. In this case, MRI is always preferable due to the absence of radiation exposure.
We always perform an ultrasound examination before surgery to rule out additional upper abdominal hernias (epigastric hernias) and rectus diastasis.
In patients with a new abdominal wall hernia who are older than 50 and who have not yet had a colonoscopy, this examination should definitely be performed as a preventive examination before surgery in order to rule out an intestinal tumor.
IMPORTANT: Preventive colonoscopy is recommended for men over 50 years of age and for women 55 years of age, and the costs are covered in full by public and private health insurance companies.
What are the symptoms of an umbilical hernia?
Most of the time, patients have no complaints, so they are asymptomatic. Many are not even aware that they have a small umbilical hernia.
In addition to the aesthetic problem, there is more often a rather pulling discomfort in the abdominal area around the navel. This can be aggravated especially during exercise or sports activities. Also, because of this, the navel is often very sensitive to touch in many people.
In the case of larger umbilical hernias, the skin can become inflamed due to the pressure and lead to oozing. In this situation, surgery should always be performed.
However, an umbilical hernia can also become stuck (incarceration). In this case, most of some fatty tissue gets stuck and swells a lot, causing inflammation, which is painful. Because of the pain and inflammation, this is an emergency that should be operated on quickly. The probability of this happening is about 6-8% in the course of life with an existing umbilical hernia.
If the intestine is trapped, it is always a life-threatening emergency that must be operated on within 6 hours. In this case, the patients have very severe abdominal pain with nausea and vomiting. Fortunately, this is very rare.
How to operate the umbilical hernia?
The method of surgery depends very much on the size of the umbilical hernia and any concomitant hernias.
Umbilical hernia under 1cm size
These umbilical hernias are usually treated with a suture that does not dissolve. A plastic mesh is not necessary. Standard is the outpatient (without overnight stay) surgery in a practice.
For this purpose, a small cross-section of about 2cm is made at the upper or lower edge of the navel. The gap in the firm connective tissue (fascia) is closed with several sutures, which do not dissolve. The skin is sutured with a thread over it, which dissolves. Stitches do not need to be removed.
Surgery details
- General anesthesia: yes
- Hospital: Usually no, outpatient procedure
- OP duration: 20 - 30 minutes
- Scar: small, about 2cm
- Unable to work: 7-14 days
- Normal movement: immediately
- Jogging, swimming, cycling: After 2 weeks
- Weight training: After 6 weeks
Umbilical hernia of 1-2 cm size
According to the guidelines, a mesh should be inserted here for hernias over 1cm. This can be inserted under the abdominal wall in the abdominal cavity as an IPOM or between the peritoneum and the abdominal wall as a PUMP. For hernias less than 1.5cm, mesh insertion should always depend on circumstances such as rectus diastasis, age, and the strength of the connective tissue.
Standard here is also the outpatient (without overnight stay) operation e.g. in a surgery, in case of risk factors in hospital.
Here, too, a small cross-section of about 3cm is made at the upper or lower edge of the navel. The mesh is inserted and the gap in the firm connective tissue (fascia) is closed with several sutures that do not dissolve. The skin is sutured over it with a thread, which dissolves. Stitches do not need to be removed.
In the case of mesh inserts, we recommend wearing an abdominal bandage for 4-6 weeks.
Surgery details
- General anesthesia: yes
- Hospital: Usually no, outpatient surgery
- OP duration: 30 - 50 minutes
- Scar: small, about 3cm
- Unable to work: 7-14 days
- Normal movement: immediately
- Jogging, swimming, cycling: after 2 weeks
- Weight training: After 6 weeks
- Abdominal bandage for 4-6 weeks
Umbilical hernia over 2 cm in size
A mesh must always be inserted for these hernias. The meshes are considerably larger, up to 20 cm long and 15 cm wide, so that these operations are performed as in-patient operations in hospital.
The meshes are usually placed under the straight abdominal muscle using the sublay method. The MILOS method has become established in experienced centers, in which the meshes are inserted safely through small incisions. There is no contact of the mesh with the abdominal cavity.
In more obese and older patients, the minimally invasive keyhole technique as IPOM is also well possible. Because of the larger wound area, patients stay in the hospital for at least 2 nights.
Wearing an abdominal bandage for 6 weeks is recommended.
Surgery details
- General anesthesia: yes
- Hospital: yes, 2-5 days
- OP duration: 60-180 minutes
- Scar: medium, ca 6cm
- Unable to work: 7-21 days
- Normal movement: immediately
- Jogging, swimming, cycling: after 2 weeks
- Weight training: After 6-8 weeks
- Abdominal bandage for 6 weeks
What is the aftercare of an umbilical hernia?
Wound inspection is most important in the post-operative treatment of an umbilical hernia. It is rare for wounds to become infected, but a small coughing stimulus after surgery, can cause a bruise (hematoma), which can become infected.
Infection is manifested by pain, swelling, hyperthermia, discharge, smell.
In this case, immediate presentation is required and can usually heal without problems after a small miracle opening and irrigation.
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