Umbilical Hernia

Definition

An umbilical hernia is a hernia (protrusion of fat or intestine through a small hole in the abdominal wall layer called fascia) that is located in or near your belly button. Umbilical hernias are common and come in many sizes ranging from small (less than 1 cm) to medium (1 cm to 3 cm) to large (greater than 3cm). Umbilical hernias can be asymptomatic or cause pain. They can be reducible (able to push back in) or incarcerated (always out). Not all umbilical hernias need to be repaired. Discuss your umbilical hernia with your surgeon to see if a repair is recommended. Most epigastric hernias are very similar to the umbilical hernia, just located a little higher up than the belly button. Recovery instructions after the repair for epigastric hernias are usually the same as for umbilical hernias.

Presentation

Umbilical hernias can present as a bulge or pain (or both) in your abdomen. Some have no symptoms at all.

Next steps for you

If you think you have an umbilical hernia, then make an appointment with a hernia specialist to discuss your options. The smaller the umbilical hernia, the more surgical options that are available. Believe it or not, there are over 10 different ways that are considered standard when repairing an umbilical hernia, so be sure to discuss your options with your surgeon.

Imaging is useful only for certain cases of umbilical hernias, as most umbilical hernias can be diagnosed without an image (sonogram, CT scan, or MRI). If done, an image can help identify the hernia size, contents, and other hernias you may or may not also have.

Repair options are numerous and include:

  • open primary repair
  • open mesh repair (mesh can be placed inside your abdomen, between the muscle and peritoneum, or as an onlay on top of the fascia layer).
  • laparoscopic or robotic mesh repair. Both of these are considered minimally invasive surgery (MIS) repairs. (MIS) repairs can be done with or without defect closure. Mesh can be placed intraabdominal or between the peritoneum and muscle. Suture fixation, tack fixation, or a combination are common. Ask your surgeon about the technique and mesh they prefer for your case.

Some surgical risks include, but are not limited to:

Recurrences, chronic pain, bowel obstruction, enterotomy, mesh erosion, fistula, seroma, hematoma, and infection.

Surgical Preparation

Patients with obesity (BMI greater than 35) should try to lose weight to keep a body mass index less than 35 if possible. This will minimize the risk of an additional recurrence.

Patients must quit smoking.

The night before surgery:

Your surgeon will provide you with special instructions as needed. In general, we advise you to take a routine shower the night before and clean your belly button well. Take all your routine medications unless instructed otherwise. Some surgeons will tell you not to take some diabetic medications. Blood thinners and aspirin should be held before surgery, but this must be discussed with your surgeon ahead of time to establish how long to hold these medications and if a short-term blood thinner is needed during the perioperative period.

You can eat a normal meal for dinner but should have no food or drink after midnight.

The day of surgery:

Arrive at your surgery center or hospital 1 to 2 hours before your scheduled time. Instructions for this will be provided for you.

Recovery:

You will wake up from general anesthesia in the recovery room (unless local anesthesia is used).

Any immediate discomfort will be managed by the anesthesia and recovery room nursing teams.

While in the recovery room, you may experience immediate postoperative nausea, pain, dizziness, and fatigue. These will all fade quickly. If you had general anesthesia, your throat may feel sore for up to 3 days. This is from the breathing tube and can be managed with lozenges or tea with honey. If you did not have general anesthesia, you will not experience this.

While in the recovery room, the nurses will monitor your vital signs, and eventually get you up from the stretcher into a chair, and then provide you with something light to drink. Within about 2 hours after surgery, you will be able to stand and even walk slowly.

You may be discharged after being able to void and drink liquids without significant nausea or vomiting, and after being able to walk without any dizziness. The average patient is discharged 2-4 hours after the surgery ends (some quicker, some slower).

We recommend no driving for the first 2-4 days, and certainly don’t drive while taking pain medication.

You will be given a prescription for pain medication. It has a side effect that includes, but is not limited to, nausea and constipation. Most patients report that they use a total of 5 tablets of this pain medication over the first 2 days after surgery, at which point they do not need any pain medication. Some patients report only needing to use extra-strength Tylenol® for several days.

While at home:

The typical recovery after an umbilical hernia repair is associated with mild to moderate incisional pain or mild discomfort. This may last anywhere from 2 – 14 days but is almost always gone by the 3rd or 4th week after surgery. By the 3-6 month post-operative visit, less than 0.1% of patients are symptomatic.

Your incisions will have a bandage on them. Specific instructions for wound care will be provided upon discharge from the hospital. In general, you may remove the outer bandage after 2 days, and the white tape or skin glue after 7-10 days. You may keep ice on the incision for the first day or two as needed.

You may resume your normal diet when you are ready.

Activity: You will be able to stand, walk, and climb stairs with some mild discomfort starting the same evening of surgery.

You may shower the first day after surgery, but no bathing or swimming for 5 days.

Regarding exercise, we encourage you to try to walk, use a treadmill or use a stationary bike without any resistance the first or second day after surgery. Heavier exercising at the gym, running, or lifting more than 25 pounds can generally resume without restriction after 3 to 4 weeks, or when completely pain-free, whichever occurs first.

The majority of patients report that they are able to return to work without restrictions after 3 – 7 days.

Follow up with your surgeon within the first 2 weeks after surgery.

While we believe the recovery from an umbilical hernia repair is rapid, please allow yourself up to 3 weeks to feel completely normal/back to your baseline again.

Recovery times and experiences will always vary depending on patient, surgeon, and technique factors.

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