Umbilical hernia repair

Published by Bupa's Health Information Team, June 2010.

This factsheet is for people who are planning to have an umbilical hernia repair, or who would like information about it.

An umbilical hernia is when the belly button pops outwards or a lump appears around it due to a weakness in the muscles in or around the belly button.

This factsheet is relevant for both adults who are having an umbilical hernia repair and parents of children who are having the procedure. However, for simplicity we will refer to 'you' throughout.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About umbilical hernia

An umbilical hernia can happen at any age but it's most common in babies. The belly button is a weak area in the muscle wall because it is the area through which blood vessels pass to feed the developing foetus in pregnancy. If this area of muscle wall fails to close completely when the baby is born, an umbilical hernia develops. The hernia usually improves in children by the age of four without needing treatment. 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.

Adults can also get an umbilical hernia, particularly women during and after pregnancy, and people who are overweight. The umbilical hernia occurs either because the weak area from childhood re-opens, or a new weakness develops nearby (called a paraumbilical hernia). An umbilical hernia isn't dangerous in itself, but more often in adults there is a risk that the bowel tissue (intestine) will get trapped within it. This can cut off the blood supply to the bowel or the loop of intestine trapped in the hernia and cause life-threatening conditions such as bowel obstruction, gangrene or peritonitis. If this happens, the hernia is said to be strangulated and you will need an emergency hernia repair operation.

If you think you have an umbilical hernia, it's important that you seek medical advice.

Diagnosis of umbilical hernia

Your GP will ask about your symptoms and examine you.

What are the alternatives to surgery?

Surgery is the only effective treatment. The weakness in the muscle layer needs to be repaired. Without this, an umbilical hernia is likely to get larger and become more uncomfortable. There is a risk that it can cause serious complications if it's left untreated in adults. The risk of complications increases with the size of the hernia. Once an umbilical hernia has been diagnosed, your GP will usually recommend that you have it repaired.

Preparing for your operation

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

An umbilical hernia repair is usually done as a day-case procedure under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may prefer to have the surgery under local anaesthesia. This will completely block any feeling around your belly button area and you will stay awake during the operation. A sedative may be given with a local anaesthetic to help you relax. Your surgeon will advise which type of anaesthesia is most suitable for you.

If you have 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

The operation takes 20 to 50 minutes depending on the method used.

The aim of a hernia repair operation is to push the contents of the hernia back into the abdomen and repair the weak area in the muscle wall.

There are two main types of hernia repair operation - open and laparoscopic (keyhole). Keyhole surgery is generally recommended if the hernia has reoccurred after a previous operation.

Open surgery

A small cut is made just above or below your belly button, and the hernia is pushed back into place. The weak area within the muscle is stitched together and often a synthetic mesh is stitched over this to further strengthen the abdominal wall. The cut is closed with dissolvable stitches and covered with a dressing.

Keyhole surgery

Two or three small cuts are made towards the side of your abdomen. Your surgeon will insert a tube-like telescopic camera (laparoscope), so he or she can view your hernia on a monitor. The hernia is repaired using specially designed surgical instruments that are passed through the other cuts. A synthetic mesh is fixed to the under-surface of your abdominal muscles, to strengthen the abdominal wall. The cuts are closed with dissolvable stitches and covered with a dressing.

What to expect afterwards

If you have general anaesthesia, you may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthesia wears off.

You will be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

A nurse will give you advice about caring for you healing wound. You may be given a date for a follow-up appointment.

Dissolvable stitches will usually disappear in about 10 days.

Recovering from umbilical hernia repair

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. Don't give aspirin to children under 16.

General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you are in any doubt about driving, always follow your surgeon's advice and please contact your motor insurer so that you are aware of their recommendations.

You will need to take it easy in the first few days. You should be able to return to normal activities after about two weeks. Light exercise, such as walking, will help to speed up your recovery.

You should eat plenty of vegetables, fruit and high-fibre foods such as brown rice and wholemeal bread and pasta. This helps to prevent constipation, which can cause straining and discomfort.

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, first seek advice from your doctor. Children should stay off school for a few days.

What are the risks?

Umbilical hernia repair is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example feeling sick as a result of the general anaesthetic. You will have some pain, bruising and minor swelling in your lower abdomen. The side-effects are usually milder after key-hole surgery.

Complications

Complications are when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Complications may require further treatment such as returning to theatre to stop bleeding, or antibiotics to deal with an infection. Specific complications of an umbilical hernia repair include:

• the umbilical hernia re-occurring
• damage to your bowel during the operation, but this is rare

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.