What Is An Umbilical Hernia?
An umbilical hernia is a weakness or a defect in the abdominal wall in the area around the umbilicus. A piece of fat or bowel from the abdomen will protrude through the defect and causes a bump that you can see. Anatomically the umbilicus is the weakest point of the abdominal wall due to the umbilical cord at the time of birth. Many newborn babies have an umbilical hernia that usually heals on its own soon after birth.
What Causes Umbilical Hernias?
Just like other types of hernias, multiple factors can contribute to umbilical hernia formation.
- Age: Umbilical hernias are more common in children but they can also happen in adults.
- Obesity: Excess weight is not only a risk factor for developing umbilical hernias but also for recurrence after repair.
- Pregnancy: As the abdominal wall expands during pregnancy the weak area of the umbilicus can form hernias.
- Heavy lifting: Heavy work or heavy sports (CrossFit, Football).
- Coughing: Patients with emphysema or COPD, smokers or chronic allergies.
- Genetics: Many patients have close family members with a history of hernias.
- Prior Hernias: Personal history of other hernias.
- Liver disease: Due to the formation of ascites.
Symptoms Of An Umbilical Hernia
Many patients with an umbilical hernia are asymptomatic. This is particularly true for small and reducible hernias. Hernias tend to enlarge over time and symptoms can develop at the time. The most common symptom associated with an umbilical hernia is pain around the belly button.
Symptoms can be more pronounced during certain activities. Most patients complain of pain during lifting, coughing, jumping, reaching or standing/walking for long periods of time. The pain is usually described as a burning sensation around the umbilicus.
If a hernia becomes incarcerated or strangulated the pain can get severe. The patient can also develop abdominal pain, abdominal distention, nausea and/or vomiting. Lack of flatus or bowel movements can also be present if a portion of the bowel is incarcerated or strangulated. If any of these symptoms develop rapid medical attention is needed.
Belly Button Hernias
How Is An Umbilical Hernia Diagnosed?
The diagnosis of an umbilical hernia is usually very straight forward. A good history and physical exam is normally the only thing needed to make an accurate diagnosis.
In more complex cases radiologic evaluation might be needed. A CT scan is the test of choice for most surgeons. CT scans are very sensitive at diagnosing hernias but unfortunately, very small hernias are difficult to visualize.
An MRI can also be useful but usually not necessary.
Many physicians will obtain an ultrasound as the first test but the sensitivity is low and is highly dependent on the sonographic technologists.
How Are They Treated?
Many years ago the recommendation was that every hernia had to be repaired. In more recent years that has changed. Currently, the decision to repair an umbilical hernia is base on the symptoms. For a completely asymptomatic hernia that doesn’t limit the patients daily activities, watchful waiting is not unreasonable.
For an umbilical hernia that is enlarging, causing pain or limiting the patients daily activities, elective surgical repair is routinely recommended.
For hernias that are incarcerated and/or strangulated that are causing significant pain, surgical repair is usually mandatory and sometimes an immediate repair is warranted.
Below we will discuss the three main approaches to repair an umbilical hernia. We will also discuss a very common question that patients have nowadays. Do I need mesh?
Open umbilical Hernia Repair
An open umbilical hernia repair is done through a 4-5 cm incision just below the umbilicus. The defect in the abdominal wall is identified and using a combination of sutures and mesh the defect is repaired. The surgery time is approximately 30-45 minutes and the surgery is an ambulatory procedure. This can vary base on the hernia size and the patient’s body habitus.
The decision to go with an open approach is made base on the hernia size, the patient’s body habitus and/or the patient’s medical condition. A small umbilical hernia on a thin patient is usually well suited for an open repair.
A giant incarcerated umbilical hernia is also better suited for an open approach were reducing the intestine back into the abdominal cavity can be a significant challenge.
Laparoscopic Umbilical Hernia Repair
The laparoscopic approach is done with 3-4 incisions on the sides of the abdominal wall. The surgical time is approximately 30-60 minutes and is an ambulatory surgery. A laparoscopic umbilical hernia repair has to be done under general anesthesia.
A mesh is placed against the abdominal wall and it is secured with small “nails” and sutures to the abdominal wall. The mesh has a special coating to prevent adhesions of the bowel to the mesh.
One of the big advantages of the laparoscopic approach is the ability to place a larger mesh. That will create more coverage of the defect and potentially decrease recurrence.
Robotic Umbilical Hernia Repair
Robotic umbilical hernia repairs have become more popular in recent years. The hernia is repaired similarly to a transabdominal laparoscopic repair. The biggest difference is the set of tools. Robotic surgery fans advocate that the DaVinci system give the surgeon more accuracy and better visualization when dealing with delicate tissues.
In Dr. Caban’s practice most minimally invasive umbilical hernia repairs are done with the DaVinci robotic system. Doctor Caban has found that patients have less pain when compared to the laparoscopic approach. Using the robotic system, he also has several different approaches to repair the same umbilical hernia. That was not possible or it was significantly more difficult with the laparoscopic instruments versus the more versatile articulating robotic arms.
Umbilical Hernia Repair
Mesh Or No Mesh?
If you watch any television most likely you have seen a commercial about mesh recall or mesh complications. The truth is that these commercials are not new. Mesh complications, recalls, and infections have affected patients for decades. Mesh is like any other medical device, they can be defective or they can cause issues in certain patients.
Many clinical trials have looked into these issues and the conclusion is always very similar. The best way to fix a hernia is with mesh. Mesh placement has proven to decrease the recurrence rate by reinforcing the tissues and by creating tension-free repairs. Some patients complain of chronic pain due to the “mesh”, but the chronic pain can also develop in patients with a non-mesh repair. The incidence of chronic pain after a hernia repair is around 2-5% for all hernias.
There are many types of mesh, permanent mesh, absorbable mesh, and hybrid meshes. Also inside these three broad catergories, you can find different materials made by different manufacturers. Selection of the type of mesh is usually determined by the surgeon and many times the surgeon is limited to whatever product is available at the institution where he or she operates.
If you have concerns about the mesh product that will be used in your surgery you should ask your surgeon. Dr. Caban is an advocate of mesh placement in most hernia repairs, but he is also opened to discussions with the patients regarding what product will be used and what the outcomes data is for that product.
So to answer the question of mesh or no mesh. The short answer is that most hernias are better repaired with mesh.
Post Operative Period
What Happens After Umbilical Hernia Surgery?
An umbilical hernia repair is an ambulatory surgery in most instances. That is true for the open, laparoscopic or robotic approach. The surgery takes between 30 – 60 minutes. After surgery, the patients will go to the recovery room for approximately 1-2 hours. You will be given a prescription for pain medications and other instructions will be given prior to going home.
You will follow up with Dr. Caban in 2-3 weeks and then on as needed basis.
Most patients that have office type job can expect to return to work after several days. For those of you that have a labor intense job were heavy lifting more than 15-20 pounds is necessary, you should account for 4-6 weeks out of work or sooner if light duty is an option.
Other activities like playing golf, pickleball, bowling or any other sports were using the core muscles is necessary should be postponed for 4-6 weeks. Swimming should be limited until the incisions are completely healed.
What People are Saying
“Dr. Angel Caban performed my surgery almost 5 years ago on 6/2/2014. He is a kind doctor and always treated me fairly. I always felt welcome in his office. I recommended him to many over the past 5 years”.
“Me encanta no lo cambio. Exelente el doctor caban y su personal. Muy buen grupo”.
“Another successful experience”
“Dr. Caban did my colon resection and did an outstanding job all the way across the board. I highly recommend him as well”.
“Very fortunate to have him”
“I have the privilege of working with Angel M Caban in the hospital environment. I also have had him be the surgeon to one of my family members. I would like everyone to know that he is a great surgeon. We are fortunate to have him here in Ocala. He is personable, easy to talk too and has excellent bedside manners”.
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