Umbilical And Paraumbilical Hernia
Umbilical hernias are very common in paediatric care, affecting 1 in 5 of all children.
They are more common in premature babies and children with Down’s Syndrome and there is a slight familial tendency. By far the majority (85-90%) will close on their own by the age of 3. Those occurring after puberty are unlikely to. Those occurring in adulthood are usually paraumbilical hernias (ie near the umbilicus).
Symptoms of umbilical and paraumbilical hernia
Umbilical and paraumbilical hernia occurring in adults usually cause swelling around the umbilicus (belly button). They are often not painful and usually, but not always, can be pushed back in. If they become more painful or the skin overlying the lump becomes discoloured (usually red or purple), this may be an indication that trapping (incarceration) or cutting off of the blood supply (strangulation) is occurring. In this case emergency surgery may be required.
Causes of umbilical and paraumbilical hernia
Anything increasing the pressure inside the abdomen may increase the risk. This includes straining associated with constipation and poor urinary flow, being overweight, having a long-term cough or partaking in strenuous sporting activities. They are relatively common in pregnancy.
Treatment of umbilical and paraumbilical hernia
Paraumbilical and umbilical hernia should usually be repaired to relieve symptoms and prevent the risk of complications (see below). Over time they do tend to enlarge and cause more symptoms.
Paraumbilical and umbilical hernia repair is a day case operation meaning that no overnight stay in hospital is necessary. These repairs are usually carried out under general anaesthetic.
1. The conventional (or open) approach involves a small incision just below or above the belly button. The weakness in the abdominal wall is repaired – a nylon mesh is not always required. The incision is closed with an invisible dissolving stitch.
2. A laparoscopic (keyhole) repair can be carried out from within the abdomen. Very small incisions are made in the abdominal wall to enable specialist keyhole instruments to be inserted. These are then used to repair the weakness and insert a nylon mesh.
Your surgeon will discuss these options with you.
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery – with any of your regular medications). You will see your surgeon and the anaesthetist before your operation.
After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. Most people are discharged home later the same day.
You will be provided with painkillers before discharge but it is recommended that you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol may be necessary but if so it is important to take a laxative such as lactulose at the same time. You can expect to have some discomfort after surgery, but this will rapidly subside and most people are able to resume normal activities within a week of surgery. It may be slightly more uncomfortable for longer if you have had an open procedure. With both types of surgery there will still be minor twinges for some time as the tissues organize themselves. You will be able to take gentle exercise but should avoid heavy lifting or strenuous work for 2 weeks. You may drive a car when you are able to perform an emergency stop safely. There are no stitches to be removed.
You will be seen for follow-up six weeks following your surgery.
Risks of surgery
There are very few potential complications.You may develop some bruising around the belly button. If the wound swells, becomes more painful and hot, or starts to discharge, you may have a wound infection and should contact the Berkshire Hernia Centre or your General Practitioner. The risk of recurrence is around 1-2%.