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Umbilical hernia is a condition that usually results from the protrusion of the intestines or the fat tissues in the abdomen due to the weakening of the muscles around the belly button. This region is the second weakest region in the abdominal wall after the inguinal canal. The hernia, which starts as a small opening at first, grows larger over time.
Who gets umbilical hernia?
It is often seen in women. It can also be seen congenitally in children, but it usually closes spontaneously within the first 2 years without the need for surgery. In adults, surgery is often necessary.
Increased, chronic intra-abdominal pressure can cause an umbilical hernia. The following factors increase the incidence of umbilical hernia:
How is an umbilical hernia determined?
It usually manifests itself as a painless swelling that goes in and out of the navel. Rarely, a change in skin color may also occur. Sometimes the swelling in the navel cannot be pushed back and pain may occur along with it. In this case, a strangulated hernia is suspected. Since this is an emergency that can threaten life, it is recommended to seek medical attention without delay.
How is an umbilical hernia diagnosed?
Diagnosis is usually made by a physician's physical examination. It can be examined with ultrasound if necessary for differential diagnosis. Another benefit of an ultrasound is to determine whether there is another hernia in the midline. If complications have occurred, then imaging with computed tomography will be very useful in choosing treatment.
How is umbilical hernia surgery performed?
There are basically two approaches:
1. Open Umbilical Hernia Surgery
2.Closed Umbilical Hernia Surgery (Laparoscopic Umbilical Hernia Surgery)
In open umbilical hernia surgery, after the hernia is returned to the abdomen, the hole in the abdominal wall is closed with stitches and a patch.
Holes smaller than 1 cm can be repaired with sutures, but the risk of recurrence is higher than repair with a patch. Especially in obese patients, the probability of recurrence increases.
The preferred method for holes larger than 2 cm is laparoscopic umbilical hernia surgery. This method includes various advantages such as less pain after surgery, faster recovery, and a better cosmetic appearance. In this technique, a patch is placed in the abdomen. One surface of these patches is covered with a temporary or permanent anti-adhesion material so that the intra-abdominal organs do not adhere. These patches, called Composite or Dual patches, are produced with high technology and are quite expensive. Again, special staples are used to fix these patches to the abdominal wall. These staples are permanent or absorbable, depending on the surgeon's preference.
In open surgery, the patch is placed on or behind the muscle, and in the laparoscopic method, the patch is placed on the back of the abdominal wall.
Another advantage of the laparoscopic approach is simultaneous repair of accompanying midline hernias.
How long does it take to heal after umbilical hernia surgery?
You usually stay in the hospital overnight after umbilical hernia surgery and are discharged the next morning. In some special cases, the hospital stay may be extended for one more day, although it is rare. You will be informed about this before the operation. Patients are encouraged to refrain from lifting heavy objects for at least one month after surgery, as well as possibly avoiding heavy tasks for another month. It is usually possible to return to full regular activities 2-3 weeks after the surgery. There will be no dietary restrictions after the surgery.
What are the risks of umbilical hernia surgery?
In the evaluation before the umbilical hernia surgery, you will be informed about the surgical method and possible complications. Open or laparoscopic, although rare for all, there may be minor problems such as bleeding in the umbilical region and blood accumulation, which we call hematoma. If it is performed laparoscopically on the umbilical skin, bruises due to subcutaneous leaks may be seen at the trocar entry sites. This situation disappears on average in 2 weeks.
In some patients, especially those with large hernias, fluid deposits, which we call seroma, may be seen in this region after surgery. It usually occurs in the early postoperative period. This liquid is harmless and is absorbed by the body in an average of 6-8 weeks.
Another complication is wound infection. It is quite rare and easy to treat with appropriate follow-up and medication.
Intra-abdominal organ injury may rarely occur during laparoscopic repair. The important thing is to realize this during the surgery. Intestinal injury most commonly occurs and is repaired laparoscopically. However, in this case, it is recommended to postpone hernia repair as the risk of infection of the patch will increase.
The most important late complication is undoubtedly the recurrence of hernia. The reasons for the recurrence should be well known and the most appropriate surgical technique should be selected for the patient. The most important principle to reduce recurrences is to perform hernia repair with an appropriate synthetic patch. The patch should be selected according to the size of the hernia hole.
