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Adult Umbilical Hernia Repair AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION Adult Umbilical Hernia Repair Benefits and Risks of Your Operation Patient Education B e n e fi t s — An operation is the only way This educational information is to repair a hernia. You can return to your to help you be better informed normal activities and in most cases will about your operation and not have further discomfort. empower you with the skills and Risks of not having an operation—Your knowledge needed to actively Umbilical Hernia Location hernia may cause pain and increase in participate in your care. size. If your intestine becomes squeezed The Condition in the hernia pouch, you will have sudden Keeping You pain, vomiting, and require an immediate An umbilical hernia occurs when a tissue operation. Informed bulges out through an opening in the muscles on the abdomen near the navel Possible risks include return of the Information that will help you or belly button (umbilicus). About 10% of hernia; infection; injury to the bladder, further understand your operation abdominal hernias are umbilical hernias.1 blood vessels, intestines, or nerves; and and your role in recovery. continued pain at the hernia site. Common Symptoms Education is provided on: ● Visible bulge on the abdomen, Hernia Repair Overview .................1 especially when coughing or straining Expectations Condition, Symptoms, Tests .........2 ● Pain or pressure at the hernia site Before your operation—Evaluation Treatment Options….. ....................3 may include blood tests, urinalysis, and Risks and ultrasound. Your surgeon and anesthesia Possible Complications ..................4 Treatment Options provider will discuss your health history, Preparation Surgical Procedure home medications, and pain control and Expectations .............................5 options. Open hernia repair—An incision is made Your Recovery near the site. Your surgeon will repair the The day of your operation—You will and Discharge ....................................6 hernia with mesh or by suturing (sewing) not eat or drink for six hours before the Pain Control.............................................7 the muscle layer closed. operation. Most often, you will take your Glossary/References ........................8 normal medication with a sip of water. You Laparoscopic hernia repair—The hernia will need someone to drive you home. is repaired with mesh or sutures inserted through instruments placed into small Your recovery—For a simple repair, you incisions in the abdomen. may go home the same day. You will need to stay longer for complex repairs.4 Nonsurgical Procedure Call your surgeon if you have severe pain, Watchful waiting is generally not stomach cramping, chills or a high fever recommended for adults with an umbilical (over 101°F or 38.3°C), odor or increased hernia. You may be able to wait to repair drainage from your incision, or no bowel umbilical hernias that are very small, movements for three days. reducible (can be pushed back in) and not uncomfortable.2 There is a risk of the intestines being squeezed in the hernia pouch and blood supply being cut off (strangulation). If this happens, you will need an immediate operation.3 This first page is an overview. For more detailed information, review the entire document. AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation The Condition, Symptoms, Umbilical Hernia Repair and Diagnostic Tests SAMPLE Intestines Keeping You Informed Umbilical Hernia Bulge Who Gets an Umbilical Hernia? Ten percent of all hernias in adults are umbilical.2 Umbilical hernias can Abdominal Muscle suddenly bulge out. They occur more often Peritoneum (Abdominal Lining) in adults over 60 years when the muscles Hernia Location start to weaken.5 Internal View Some risk factors are: The Condition Symptoms • Older age—muscles An umbilical hernia occurs when part of The most common symptoms are: become weaker the intestine or fatty tissue bulges through ● Bulge in the abdominal area that often • Overweight and the muscle near the belly button (navel, increases with coughing or straining obesity—increased umbilicus). Most (9 of 10) umbilical hernias weight places in adults are acquired. This means that ● Pain or pressure at the hernia site pressure on increased pressure near the umbilicus ● Increasing sharp abdominal pain and abdominal muscle causes the umbilical hernia to bulge out. vomiting can mean that the hernia is • Chronic straining A reducible hernia can be pushed back strangulated. This is a surgical emergency • Family history into the opening or decrease in size when and immediate treatment is needed. lying flat. When intestine or abdominal • Ascites: excess fluid tissue fills the hernia sac and cannot in the space between be pushed back, it is irreducible or 4 the tissues lining Common Diagnostic Tests incarcerated. A hernia is strangulated if the abdomen and the intestine is trapped in the hernia pouch History and Physical Exam abdominal organs; and the blood supply to the intestine is Checks for the presence of bulge may be due to cut off. This is a surgical emergency.3 alcoholism Additional Tests (see Glossary) Herniorrhaphy is the surgical repair of a hernia. • Pregnancy, Other tests may include: particularly multiple Hernioplasty is surgical repair of a hernia with pregnancies mesh inserted to reinforce the weak area. ● Ultrasound ● Computerized tomography (CT) scan Pregnancy ● Blood tests Considerations ● Urinalysis The repair of umbilical ● Electrocardiogram (ECG)–for patients hernias during over 45 or if high risk of heart problems pregnancy is considered only if the hernia becomes incarcerated or strangulated.2 2 AMERICAN COLLEGE OF SURGEONS • SURGICAL PATIENT EDUCATION • www.facs.org/patienteducation Surgical and Umbilical Hernia Repair Nonsurgical Treatment Mesh Repair Sutured Muscle Repair Laparoscopic Repair Open Repair ● Your surgeon may inject a local anesthetic Keeping You Surgical Treatment around the hernia repair site to help The type of operation depends on control pain. Informed hernia size and location, and if it is a ● With complex or large hernias, small Open versus repeat hernia (recurrence). Your health, drains may be placed going from inside to age, and the surgeon’s expertise are the outside of the abdomen. Laparoscopic Repair also important. An operation is the There is no signifi cant evidence only treatment for a hernia repair. Laparoscopic Hernia Repair on the best technique to repair an The surgeon will make several small umbilical hernia, and more study Your hernia can be repaired either as is needed. The type of repair may punctures or incisions in the abdomen. Ports an open or laparoscopic approach. also depend on the size of the or trocars (hollow tubes) are inserted into The repair can be done by using sutures hernia. the openings. Surgical tools and a lighted only or adding a piece of mesh. camera are placed into the ports. The • When comparing open mesh repair with laparoscopic mesh Open Hernia Repair abdomen is infl ated with carbon dioxide repair, there is no diff erence The surgeon makes an incision near the gas to make it easier for the surgeon to in the length of hospital stay hernia site, and the bulging tissue is gently see the hernia. Mesh may be sutured or or recurrence rate. There is a slightly lower wound pushed back into the abdomen. Sutures fi xed with staples to the muscle around the hernia site. The port openings are closed complication rate, including or mesh are used to close the muscle. seromas, hematomas, and with sutures, surgical clips, or glue. infection, with laparoscopic ● For a suture-only repair: The hernia sac is repair.6, 8 Both types of removed. Then the tissue along the muscle operations have similar edge is sewn together. The umbilicus Nonsurgical Treatment long- term results. is then fi xed back to the muscle. This procedure is often used for small defects.6 Watchful waiting is not usually recommended • Open repairs can be done except for very small umbilical hernias.7 A with local anesthesia instead of general anesthesia and are ● For an open mesh repair: The hernia surgical repair is recommended for adults sac is removed. Mesh is placed beneath frequently done as outpatient who have symptoms, incarceration, thinning procedures. the hernia site. The mesh is attached of the skin, or uncontrollable ascites. using sutures sewn into the stronger • Strangulated hernias may tissue surrounding the hernia. The mesh Because abdominal muscles weaken with have to be repaired as an extends 3 to 4 cm beyond the edges of age, the hernia can increase in size, and there open approach. the hernia. The umbilicus is fi xed back is a risk of incarceration and strangulation.2 • The use of mesh provides a to the muscle. Mesh is often used for Abdominal binders that apply pressure and stronger repair and decreases large hernia repairs and reduces the risk push back the bulge will not repair the hernia. the rate of recurrence.9 that the hernia will come back again. • Suture repair will result in ● For all open repairs, the skin site is closed a small incision around the using sutures, staples, or surgical glue. hernia site. Laparoscopic repairs usually have 3 to 4 smaller scars ● An open repair may be done with at the site of the entry ports. local anesthesia and sedation given through an IV. 3 Umbilical Hernia Repair Risks of this Procedure SAMPLE Risks Based on the ACS Risk Calculator Open and Laparoscopic Umbilical Hernia Surgery from the ACS Risk Calculator – April 7, 2016 Percent for Risks Keeping You Informed Average Patient Wound Infection: Infection at the Open 1.2% Antibiotics and drainage of the wound may be needed. Smoking can area of the incision or near the organ Laparoscopic 0.9% increase the risk of infection. where the surgery was performed Complications: Including surgical Open 2.2% Complications related to general anesthesia and surgery may be higher in infections, breathing difficulties, Laparoscopic 3.4% smokers, elderly and/or obese patients, and those with high blood pressure blood clots, renal (kidney) and breathing problems.
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