Umbilical Hernia Surgery

Umbilical Hernia

An umbilical hernia occurs when abdominal contents such as intestine or fat protrude through a weak area in the abdominal wall near the navel (umbilicus).
It appears as a soft swelling around or just below the belly button, which may become more noticeable while coughing, crying, straining, or standing.

What causes umbilical hernia?

• Weakness in the abdominal wall at the umbilicus
• Congenital defect present since birth
• Incomplete closure of the umbilical ring after birth
• Increased abdominal pressure
• Obesity
• Pregnancy, especially multiple pregnancies
• Chronic cough or constipation
• Ascites or fluid accumulation in the abdomen
• Previous abdominal surgery near the umbilicus

What symptoms are associated with umbilical hernia?

• Visible or palpable swelling near the belly button
• Swelling that increases on coughing or straining
• Discomfort or pain at the umbilicus
• Dragging or stretching sensation around the navel
• Pain on physical activity
• Sudden severe pain if complications develop

When is medical help required?

Medical consultation is advised if an umbilical swelling is noticed, if pain increases, if the swelling becomes hard or irreducible, or if symptoms such as nausea, vomiting, redness, or fever occur.

What treatment options are available for umbilical hernia?

Non-surgical management

1. Observation may be advised in small, asymptomatic hernias in infants
2. Most childhood umbilical hernias close spontaneously by 4–5 years
3. Supportive measures do not cure the hernia in adults
4. Hernia belts provide only temporary support

Definitive treatment in adults is surgical

Surgical treatment

Open Umbilical Hernia Repair

Best used for primary umbilical hernias, large defects, patients unfit for general anaesthesia, and settings where minimally invasive surgery is not required

1. An incision is made near the umbilicus
2. Hernia contents are pushed back into the abdomen
3. The defect is closed using sutures or mesh depending on size

Pros

1. Superior visualisation and precision
2. Minimal tissue trauma
3. Less postoperative pain and quicker recovery
4. Useful for complex or recurrent hernias

Cons

1. Larger incision compared to laparoscopic surgery
2. More postoperative discomfort
3. Higher recurrence risk if mesh is not used in larger defects

Laparoscopic Umbilical Hernia Repair

Useful for bilateral, recurrent, or multiple hernias ,faster recovery, reduced pain, or better cosmetics is a priority

1. Small keyhole incisions are used
2. Camera-guided repair from inside the abdomen
3. Mesh is placed to reinforce the abdominal wall

Pros

1. Less postoperative pain
2. Smaller scars with better cosmetic outcome
3. Faster recovery and earlier return to work
4. Lower wound infection rates
5. Useful for recurrent hernias or multiple abdominal wall defects

Cons

1. Requires general anaesthesia
2. Higher cost
3. Not ideal for very small hernias

Robotic Umbilical Hernia Repair

Best used in selected patients where precision and minimally invasive benefits outweigh cost

1. Advanced minimally invasive technique using robotic assistance
2. Allows precise mesh placement and suturing

Pros

1. Excellent visualisation and precision
2. Reduced pain and quicker recovery

Cons

1. Higher cost
2. Limited availability

Why is surgery recommended for umbilical hernia?

1. Umbilical hernias do not heal spontaneously in adults
2. Size of hernia increases over time
3. Risk of complications increases
4. Surgery provides permanent repair
5. Early repair offers better outcomes

What dangers occur if umbilical hernia is left untreated?

1. Progressive enlargement of the hernia
2. Increasing pain and discomfort
3. Incarceration where hernia cannot be reduced
4. Strangulation causing loss of blood supply to intestine
5. Intestinal obstruction
6. Bowel gangrene requiring emergency surgery
7. Risk of infection, sepsis, and death in severe cases

How is umbilical hernia surgery performed?

1. Herniated contents are re-positioned into the abdomen
2. The abdominal wall defect is repaired
3. Mesh reinforcement is used for larger defects to prevent recurrence
4. Surgery may be performed using open, laparoscopic, or robotic techniques

Choice depends on hernia size, patient factors.

What are the benefits of umbilical hernia surgery?

• Permanent cure of the hernia
• Relief from pain and discomfort
• Prevention of serious complications
• Improved abdominal wall strength
• Early return to normal activities

What are the possible limitations and risks?

1. Pain or swelling at the surgical site
2. Seroma or fluid collection
3. Wound or mesh infection
4. Chronic pain in a small percentage
5. Recurrence in rare cases

How does recovery and after care progress?

1. Most patients are discharged the same day or next day
2. Mild pain and swelling are common initially
3. Early walking is encouraged
4. Strenuous activity should be avoided for 4–6 weeks
5. Return to desk work usually within 7–10 days
6. Follow-up ensures proper healing and mesh integration