Umbilical Hernia: To operate or not
Umbilical Hernia Surgery – Approximately 20% of babies in the world have umbilical hernias. An umbilical hernia at the umbilicus or belly button forms, when a loop or loops of intestine pushes through the umbilical ring. This a small opening in a new born abdominal muscles where the umbilical cord – which connects a fetus to its mother while in the womb – is connected.
Causes of Umbilical Hernia
After birth, there is an opening between abdominal muscles and can cause a hernia. Umbilical hernias occur most often in new-born’s, but 90 percent will close on their own, by the time the child reaches 5 years of age. Umbilical hernias both in infants and adults.
Most common causes of umbilical hernias in adults are the ones due to which there is a rise in abdominal pressure. These are:
- Ascites or collection of water in the tummy
- Chronic cough or expectoration
- Difficulty in passing urine
- Chronic constipation
- Recurring Vomiting
- Straining during child birth or weight lifting
- Pregnancy especially after twins
Diagnosis of Umbilical Hernia
Diagnosis of umbilical hernia is with a clinical examination. There will be a bulge or swelling in the belly button area. The swelling becomes more noticeable when a patient is asked to cough. The doctor during the clinical examination determines if the hernia is reducible, by pressing on it gently and noting if it can be pushed back into the abdomen.
Emergency surgery for Umbilical Hernia:
If the umbilical hernia is trapped within the abdominal opening, it is a serious medical condition called incarcerated hernia. In this condition the intestine becomes trapped which further can get deprived of blood supply. Once this happens, the intestine can quickly become gangrenous, if emergency surgery is not done. Once it becomes gangrenous, then a surgical removal of the affected intestine is required. The symptoms of a strangulated umbilical hernia are pain in the abdomen, constipation, fever, vomiting and the hernia bulge increases in size and becomes tender to touch.
Management of uncomplicated Umbilical Hernia:
In infants and young children, if there is no complications, surgery is deferred till age 5. Many umbilical hernias close on their own without surgery by year 1 and nearly all umbilical hernias close without surgery by age 5. If hernia becomes larger with age, is not reducible or is still present after age 5, the child’s provider may suggest that the hernia be repaired surgically. At any age if the hernia is strangulated, then immediate surgery is recommended.
All umbilical hernias in adults should be operated upon. The surgery includes placement of loop of intestines back into the abdominal cavity, closure of the opening and reinforcement with a piece of mesh to help strengthen the area where the muscles and opening is repaired. This surgery is usually done laparoscopically.
Advantages of laparoscopic surgery over open surgery is avoidance of big incision and thus early recovery of the patient. However, during laparoscopic surgery, one needs to use a special mesh as well tacking instruments and thus cost of surgery goes up. If cost is not an issue then laparoscopic repair of umbilical hernia is preferred. A small pressure dressing will be required over the umbilicus for a few days in laparoscopic surgery to obliterated the empty space under the skin and prevent formation of a seroma.
Dr. Rajeev Kapoor is a Umbilical Hernia Specialist in Chandigarh. He is a highly experienced Hernia Surgeon and has successfully performed many surgeries in Chandigarh. Book your appointment for consultation. Call at +91-9876-507-444 to get the best treatment for umbilical hernia.