Umbilical hernia repair

About umbilical hernia

You can get an umbilical hernia if a weakness develops in your abdominal wall in the area around your belly button (where your umbilical cord was attached as a baby). This allows your abdominal lining, some internal fat or even a loop of your bowel to push forward through the weak area to create a lump in or around your belly button. A hernia through the centre of your belly button is called an umbilical hernia. A hernia just above your belly button is called a paraumbilical hernia.

An umbilical hernia repair operation aims to return the contents of the hernia back into your abdomen and repair the weak area in your abdominal wall.

Diagnosis of an umbilical hernia

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will examine the bulge or swelling. This may be when you're standing up or lying down. He or she will check if the bulge can be pushed back in, and may ask you to cough while placing a finger over the hernia to see if there is a change in the swelling. Your GP may also refer you for an ultrasound scan to confirm a diagnosis.

What are the alternatives to surgery?

In adults, surgery to repair the weakness in your abdominal wall is the only effective treatment for an umbilical hernia. If you don’t have an operation to repair an umbilical hernia, it’s likely to get larger and become more uncomfortable.

There is also a risk that an umbilical hernia can strangulate if it's left untreated. This is when the contents of the hernia (usually part of your abdominal lining, internal fat or bowel) gets trapped outside of your abdomen and may become damaged. The risk of complications increases with the size of the hernia. Once an umbilical hernia has been diagnosed, your doctor will usually recommend that you have it repaired.

In children under five, umbilical hernias often get better on their own and there may be no need for surgery. However, some children may need an operation if it doesn't get better by the time they are of school age or if the hernia becomes large or causes discomfort.

Preparing for your operation

Your surgeon will explain how to prepare for your umbilical hernia repair. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

An umbilical hernia repair is usually done as a day-case operation. This means you have the operation and go home the same day. It may be done under general anaesthesia, which means you will be asleep during the operation. Alternatively, you may prefer to have the surgery under local or regional anaesthesia. This completely blocks pain from around your belly button area and you will stay awake during the operation. You may also be given a sedative – this relieves anxiety and helps you to relax. Your surgeon or anaesthetist will advise which type of anaesthesia is most suitable for you.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during umbilical hernia repair?

An umbilical hernia repair operation usually takes around 30 minutes, depending on the method your surgeon will use.

There are two methods used in an umbilical hernia repair operation – open and keyhole (laparoscopic). Your surgeon may recommend that you have keyhole surgery if your hernia has reoccurred after a previous operation.

Open surgery

Your surgeon will make a small cut just above or below your belly button, and will push the hernia back into place. If the hernia is small, your surgeon will stitch the weak area within your abdominal wall. For a larger hernia, your surgeon will repair the defect with a piece of synthetic mesh. He or she will close the cut with dissolvable stitches or clips and cover it with a dressing.

Keyhole surgery

Your surgeon will make two or three small cuts in your abdomen, away from the hernia. He or she will then insert a tube-like telescopic camera (laparoscope) which will display the hernia on a monitor. Your surgeon will pass specially designed surgical instruments through the other cuts and repair the hernia. He or she will clip a synthetic mesh to the undersurface of your abdominal muscles with stitches, covering the hernia. Your surgeon will close the cuts with dissolvable stitches and cover it with a dressing.

What to expect afterwards

If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. After a local anaesthetic, it may take several hours before the feeling comes back into your abdomen. Take special care not to bump or knock the area.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your umbilical hernia repair.

If your hernia was large and repaired using a mesh, you may have a fine tube running out from the wound. You will need to stay in hospital for one to two days until this is removed.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

Your nurse will give you some advice about caring for your healing wound(s) before you go home. You may be given a date for a follow-up appointment.

The dissolvable stitches will usually disappear in about seven to 10 days.

Recovering from umbilical hernia repair

It usually takes two to three weeks to make a full recovery from an umbilical hernia repair, but this varies between individuals, so it’s important to follow your surgeon’s advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

It’s important to keep the area dry for one to two days after your operation.

You will need to take it easy in the first few days. You should be able to return to normal activities after about two to three weeks. Light exercise, such as walking, will help to speed up your recovery. You should be able to return to work once you feel able, but if your work is strenuous and involves heavy lifting or puts a strain on your abdominal muscles, seek advice from your doctor first. Children should stay off school for a few days.

Eat plenty of vegetables, fruit and high-fibre foods, such as brown rice and wholemeal bread and pasta, as this will help to prevent constipation, which can cause straining and discomfort.

What are the risks?

As with every procedure, there are some risks associated with an umbilical hernia repair. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. After an umbilical hernia repair, you will have some pain, bruising and minor swelling in your lower abdomen. The side-effects are usually milder after keyhole surgery.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT). Specific complications of an umbilical hernia repair include:

  • an infection in your wound – this will cause redness, pain, swelling or a discharge from your wound and you will need treatment with antibiotics
  • the umbilical hernia reoccurring – you’re more at risk of this happening if you smoke, are overweight or your wound gets infected
  • damage to your bowel during the operation

What should I do if my young child has an umbilical hernia?

Answer

Ask your GP to have a look at the hernia. However, often, no treatment is needed.

Explanation

An umbilical hernia is common in children under two years old. This is when the belly button pops outwards because of a weakness in the tissues in or around the belly button. An umbilical hernia usually heals without treatment, but your child may need an operation if it doesn't get better by the time he or she is of school age or if the hernia becomes large or causes discomfort.

My child has an umbilical hernia and constipation. What should I do?

Answer

Giving your child a diet that is rich in fibre, fruit and vegetables, and having enough to drink is often all that is needed.

Explanation

Mild constipation is common in young children and umbilical hernias are generally not the cause. However, excessive straining during a bowel movement can increase swelling around the belly button.

Often, all that’s needed to relieve constipation is a diet rich in fibre, fruit and vegetables – and drinking enough fluids. But if your child is showing signs of distress (such as crying or trying to hold on) during a bowel movement, it's important you see your GP. He or she may prescribe medicine to soften his or her faeces.

Is it safe to leave the mesh inside my body after an umbilical hernia repair?

Answer

Yes, it's perfectly safe to leave the mesh inside your body.

Explanation

You may have a mesh stitched over the weak spot to strengthen the wall of your abdomen (tummy). This will help to reduce the risk of developing a repeat umbilical hernia. The mesh is made from special synthetic material and there are many different types available. Most types act as a scaffold support for your tissue to grow in to.

Do I need to follow a special diet after umbilical hernia repair?

Answer

No, you don't need to follow a special diet after the operation.

Explanation

You don't need to follow a special diet after an umbilical hernia repair but straining or stretching the healing wound will increase swelling and slow your recovery. It's important to eat a healthy diet to stop yourself from straining during a bowel movement. A diet rich in fibre, fruit and vegetables and drinking enough fluids can help prevent constipation. Mild laxatives can also help minimise any discomfort during a bowel movement.

Will I have a scar after umbilical hernia repair?

Answer

Yes, you will have a small scar above or below your belly button following an open repair, and two or three small scars towards the side of the abdomen following a keyhole repair. These should fade gradually.

Explanation

There are two main types of hernia repair operations – open and keyhole. Open surgery involves making a small cut just below or above your belly button. Keyhole surgery involves making two or three small cuts towards the side of your abdomen. The cuts are usually closed with dissolvable stitches, and heal fully in seven to 10 days. The cuts will leave small scars and these usually fade gradually.

Is it safe to have an umbilical hernia repair if I'm pregnant?

Answer

If you’re pregnant, it’s best to wait until after you have given birth to have an umbilical hernia repair.

Explanation

Most women who discover an umbilical hernia while they’re pregnant have had it since birth but just may not have noticed it before. The hernia may have been very small or not previously caused any symptoms. If you’re pregnant, the pressure of your growing baby can put stress on the weak area of your abdominal wall and cause the hernia to become more noticeable and it may be painful.

If you have an umbilical hernia repair, you may need to have a general anaesthetic. This can be potentially harmful to your baby so it’s best not to expose your baby to this risk and to wait until after you have given birth to have the operation. Having a hernia shouldn’t affect the delivery of your child.

However a possible complication in anyone who has an umbilical hernia is strangulation. This is when part of your bowel gets trapped outside your abdomen. This is very serious and can damage your bowel. If this happens, you will need to have an umbilical hernia repair operation immediately. Rather than general anaesthesia, you may be able to have the operation under local anaesthesia as this wouldn’t pose a risk to your baby. However, this may not always be possible.

This complication is rare and for most pregnant women with an umbilical hernia, they are able to safely wait until after they have given birth to have an umbilical hernia repair. The operation shouldn’t affect any future pregnancies you have.

If you have any concerns or further questions about pregnancy and umbilical hernias, ask your GP for advice.