Overview
Umbilical hernias are very common, due to a congenital weakness in the region and often worsened by the strain of abdominal obesity. Very small hernias are often not troublesome, but with any size the contents can readily protrude and become trapped and painful. Usually only fatty tissue is present in very small hernias, and pain only results if the hernial contents become tight If bowel becomes trapped in the hernia, the problem is very serious and may even be fatal. Surgical repair of umbilical hernias is usually required.
Repair Type
The type of repair used will depend on the size of the patient and the hernia, and will vary quite a lot. In general a small incision skirting the umbilicus will be used and the repair carried out with heavy nylon sutures and often mesh reinforcing. A mesh patch or plug is often required as without mesh the recurrence rated is unacceptably high. Even if mesh is utilized some 10% of patients will develop a further hernia in the area. This is because there is often major weakness in the middle of the abdominal wall from the umbilicus up almost to the breastbone. No muscle is present in this area and the patient may develop multiple holes in this area above the umbilicus. A small mesh patch in the umbilicus won’t prevent a subsequent hernia developing above this. If this problem is apparent it may sometimes be preferable to repair the whole of the upper abdominal wall midline merely than a simple local repair of the umbilical hernia.
Surgery
The surgery for repair of an umbilical hernia is usually carried out under general anaesthesia with long acting local anaesthesia injected while asleep under anaesthesia. Many patients with small hernias can leave hospital the same or the next day. Sutures are usually positioned deep to the skin and are dissolvable. Scarring is usually minimal and is situated at one edge of the umbilicus. With a large hernia redundant skin can leave a bulge for some time and it is sometimes preferable to totally excise the umbilicus, leaving a single scar. This is quite an odd appearance.
Post Operative Instructions
Post operative instructions are the same as for inguinal hernias, get mobile. Leave the wound covered only for a few days. For the general complications of surgery and anaesthesia, see the information supplied with inguinal hernia repairs.
Some fluid collection after surgery is common, as quite a cavity can be left once a hernia is reduced and it can fill with fluid. Infection is not at all uncommon, because of the above and because bacteria lurk in the hot moist depths of the umbilicus. Preoperatively I ask patients to thoroughly clean out the base of the umbilicus with cotton buds several times a day using a skin antibacterial cleanser, obtained from any pharmacy. Antibiotics are given during operation to further reduce the risk of infection. Infection presents some days after surgery with increasing redness, swelling and increasing pain of the wound. Usually infection will settle with antibiotics and dressings. Should a mesh become infected it would have to be removed.
Mesh Utilisation Information
The mesh utilized in the repair can be in the form of a small sheet or a plug or both. Mesh can be positioned in front of the abdominal wall, or behind it. I normally utilize the latter position as less external dissection is required resulting in less post operative pain, fluid collection, and infection risk.
Normal mesh is not inserted directly into the abdominal cavity as bowel can adhere to it causing obstruction or even holes into the bowel. Special coated mesh to which bowel does not normally adhere can be inserted into the abdominal cavity. Normal mesh when used deep to the muscle is positioned outside the deep lining layer of the abdominal wall so bowel should not adhere. One possible complication of surgery is that it is possible that in spite of precautions, bowel could adhere, if in contact with mesh.
With a mesh patch or plug in the umbilicus future laparoscopic surgery through the umbilicus is often impossible because of dense scarring and a surgeon would have to insert this instrument elsewhere to enter the abdominal cavity.