Umbilical Hernia (Infants, Adults) Symptoms, Surgery, Repair

What is an umbilical hernia?

An umbilical hernia is a protrusion of the abdominal contents through the abdominal wall at the site of the umbilicus (navel, belly button). Umbilical hernias are more commonly seen in infants but may also occur in adults, particularly in females. These hernias can either be congenital (occurring from the time of birth) or acquired (develops during life).

Complications of umbilical hernias are not common unless there is co-existing ascites  (fluid accumulation in the abdomen). Rarely an umbilical hernia can lead to strangulation or rupture, especially in patients with ascites, which progresses to peritonitis and may result in death if left untreated.

Red more on types, causes and risk factor of hernias under What is a Hernia?

Symptoms of Umbilical Hernias

Most umbilical hernias, especially those in children are congenital and the majority of cases close spontaneously within 2 years of age. A persisting congenital hernia however may require surgical repair. An umbilical hernia appears as a bulge of the umbilicus, which is more clearly evident when the intra-abdominal pressure is increased like during crying, sitting up or straining.

There is a higher incidence of umbilical hernias among African American infants. In some children, umbilical hernias may be acquired due to weakness of the umbilical scar, but these hernias are usually small and self limiting and disappears as the child grows.

Acquired umbilical hernias in adults are not true umbilical hernias but rather paraumbilical hernias. The protrusion is through the linea alba near the umbilicus and not through the umbilical scar. These hernias are more common in women. Risk factors for umbilical hernias in adults includes conditions that increase intra-abdominal pressure like pregnancy, obesity and ascites. These hernias can gradually increase in size and hang downward.

The size of an umbilical hernia may vary but hernias less than 1 centimeter in diameter are usually missed. Most symptomatic hernias vary between 1 to 5 centimeter in diameter.

Lower abdominal pain, change in skin color and tenderness at the site, an irreducible swollen hernia, abdominal distension and/or fever may all be signs complications of an umbilical hernia and require immediate surgical attention.

Umbilical Hernia Surgery

Small umbilical hernias which are asymptomatic and barely visible on examination do not require surgical repair. Symptomatic umbilical hernias, large hernias, irreducible hernias, or hernia with massive ascites should undergo surgical hernia repair.

Umbilical Hernia Repair

Small defects in the umbilical scar are managed by separating the hernia sac from the umbilicus. A prosthetic mesh is used to repair defects which are more than 3 centimeters in diameter. The mesh may be used in different ways. It may be used to bridge the defect or may be used to reinforce the surgical repair by placing the mesh below the suture. In large or recurrent hernias mesh can be placed laparoscopically under general anesthesia. A surgical procedure called vest-over-pants repair used to be employed frequently in the past, but was associated with a high recurrence rates and is rarely used these days.