Repair of Umbilical (bellybutton) Hernia
A hernia is a bulge that has formed when the internal organs of the body push through a weak spot in the abdominal wall.
Umbilical hernia is the bulge that forms near the navel or belly button, when a part of the intestine, fat or fluid is pushed out through a weakened muscle of the abdomen. Umbilical hernia can be found in both children and adults.
In infants and young children, a hernia may be caused by the small muscular opening where the umbilical cord passes to the failing to close completely after birth. This leads to a weak spot near the navel, which allows internal organs of the abdomen to push through it. In children, the hernia generally resolves spontaneously by 2 years of age, if not surgery may be recommended.
Some adults may have a weakness around their umbilicus that has been present and unnoticed since birth. Various health issues that can put pressure on the abdomen, such as being overweight, pregnancy, having ascites (excessive fluid in the belly) and may lead to the development of umbilical hernia. Other situations such as lifting heavy objects, strain on the abdominal muscles to pass stools (constipation) or urine (often due to large prostate gland), a chronic cough (in smokers or asthmatics) may cause an umbilical hernia.
The main symptom of an umbilical hernia is the presence of a swelling or bulge near the navel which ranges from about 1 to 5 cm in diameter. The hernia cause pain, discomfort and increase in size over time.
Umbilical hernias have a risk of getting trapped and strangulated, thereby cutting off the blood supply to the trapped part. This may cause the trapped tissue to die (necrosis) and result in severe complications. If you experience the following symptoms, you should immediately consult your doctor:
- Tender, painful, swollen or discoloured bulge
- Severe abdominal pain
To diagnose umbilical hernia, your doctor will enquire about your symptoms and your medical history.
Physical examination is generally conducted for determining the size and prominence of the umbilical hernia. Your bulge will be examined when you are standing and lying down. Your doctor may try to reduce the bulge by pushing it inside your abdomen, and will ask you to cough to see if there is any change in size of the bulge.
Your doctor may also order blood tests and imaging tests to confirm the diagnosis:
- Imaging tests such as an ultrasound (USS) or computer tomography (CT) scan may be ordered to determine that part of the internal organ that is protruding into the bulge.
- Blood tests may be ordered to confirm a strangulated hernia by checking the white blood cell and red blood cell count. Infection, inflammation, tissue death or bleeding can be detected with blood tests.
In adults, a painful and enlarged bulge is usually treated with surgery. Surgery can prevent further complications of the hernia (strangulation). However, hernias without symptoms may not require repair.
Your surgeon may perform either an open surgery or a keyhole surgery (laparoscopy) for repairing the umbilical hernia. Laparoscopy may be recommended if the hernia has reappeared after previous open surgery. The size of the hernia and the preference of the patients are considered for deciding between open and laparoscopic repair.
Keyhole surgery (laparoscopy): Your surgeon will make two to three small incisions away from the bulge (in the flank) and insert a laparoscope (a fibre-optic tube with a light source and camera attached to it) and other special instruments through the incisions. The bulge will be pulled into the abdominal cavity, and the abdominal wall may be stitched prior to a specially designed soft plastic mesh being placed to support the weak part of your abdominal wall.
Open surgery: The size of the incision will depend on the size of the hernia. Usually a curved incision is placed below the bellybutton. The hernia is identified and either removed or pushed back into the abdominal cavity. The weakness in the abdominal wall is then closed, either with strong sutures or a mesh placed over the weakened area to support it.