IntroductionMost of us would have heard the term hernia and would be aware of the belly button, known as the umbilicus or navel. A defect or a hole in this area leads to a protrusion or a bulge at the umbilical region which is commonly referred to as Umbilical Hernia. This is the point we are all attached to our mothers while being inside the womb and the path for blood and nutrition for development of the baby.
Who can develop an Umbilical Hernia?Literally anyone right from the new born baby to the elderly grandma or grandpa can develop a hernia in the region of the belly button. It is relatively more common in women, people who are obese or have chronic conditions (constipation, liver disease, smokers, asthma)
What should one look for?A small hernia at the belly button area may not be obvious. A discomfort or pain at the umbilicus while exercising or working, a small bulge or a change in the shape of the umbilicus is usually the first sign of a hernia. Some patients can present with a swelling, severe pain, vomiting and a bloated stomach which are all signs that the umbilical hernia is getting complicated and would need urgent medical help. In infants and babies parents or grandparents can easily notice this.
Is Umbilical Hernia Life threatening?Usually these hernia are painless and apart from the disfigurement or odd shape, many individuals would be comfortable. As highlighted above, if the hernia is complicated then it can be potentially serious because of blockage of the intestines that are stuck in the umbilical hernia.
What is the hernia made up of?Any hernia is a hole or a small defect in the muscle layer of the anterior abdominal wall through which a balloon like thin sac protrudes out. This sac contains fat (greater omentum) or intestines. Larger the hernia, more in the space for the fat and intestines to get collected giving rise to a obvious large swelling when the patient coughs or stands upright.
Can Umbilical hernia get infected?Not a regular occurrence, infections are noted in people who have a large hernia with self neglect and in people who have chronic liver disease and fluid in the abdomen. In such cases, skin can get damaged and infected, with time the infection spreads into the hernia. Uncommonly, when the hernia is obstructed and ignored for a few days, the fat and intestines trapped within the hernia slowly die due to lack of blood supply, leading on to infection. Such group of patients would be ill and would need urgent medical care that has a higher incidence of complications and patients may need to be in the ICU or hospital for a longer period.
Is there any medical treatment?There is no medical treatment in the strict sense for umbilical hernia. Based on the case a wait and watch policy is advocated and this is often misunderstood as medical treatment by some. In frail individuals who cannot tolerate any form of surgical procedure some doctors advise the use of a hernia belt. This has to be individualized and monitored as inappropriate case selection or use of belt can lead to complications rather than being useful.
Are there any tests to detect the Umbilical Hernia?When the hernia is obvious, the doctor or surgeon can easily feel and assess the hernia. An Ultrasound of the abdomen and pelvic region is often done to look for other diseases in the abdomen that can influence the treatment plan. This includes assessment of the liver, to look for abdominal fluid (ascites), to rule out large ovarian tumours or abdominal cysts. This also helps in people who have pain and discomfort but no obvious swelling is noted either by them or the doctors.
When is surgery performed for Umbilical Hernia?If there are signs and symptoms of a complication, then surgery is advised immediately to prevent further adverse events. If the hernia is uncomplicated, then surgery is advised effectively (when patient, family and others can arrange time and their duties accordingly).
In children, as far as umbilical hernia is concerned, a wait and watch policy is suggested rather than early surgery. Often small hernia closes in babies by the age of 2 years. Only when the hernia is large or gets complicated, surgery is considered early. This needs the attention of specialists paediatric surgeons.
What kind of surgery is performed?For Umbilical hernia in adults, either on open or standard hernia operation or a key hole (Laparoscopic) surgery is carried out based on patient, hospital and resource factors.
In open surgery, a cut (incision) is made around 5-8 cms based on the size and thickness of the abdominal wall, hernia pushed inside, the hole in the muscle layer closed and a synthetic prolene mesh (medical grade net like material) placed to strengthen the muscle layer. In key hole surgery three small cuts (5mm-10 mm) are made and the similar repair done. There are many types of meshes available and the choice is guided by the type of surgery (open or key hole). In some center, if the patient can afford, Robotic surgery is also performed for umbilical hernia but is not mandatory.
Is the surgery safe?With the advances in anaesthetic practice, monitoring, drugs and surgical technique, Umbilical hernia surgery is safe with the acceptable complication rates related to anaesthesia, pre-existing cardiac, liver and renal disease. Surgery can be performed under general or regional anaesthesia. Presence of complications, dead (gangrenous) intestine and fat, chronic liver disease, significant cardiac illness etc increases the risk profile.
How long does it take to recover after surgery?If the patient is fit and healthy, surgery goes on smoothly then umbilical hernia surgery is often a overnight stay with most patients going home in the next couple of days. Large, complex or complicated umbilical hernia surgery or patients with other significant diseases many need to stay in for a few more days.
Can the hernia come back after surgery?Yes, potentially any hernia can come back after surgical intervention. This is termed as recurrence and is more in patients who have increased intra-abdominal pressure (chronic cough, constipation, liver disease, smoking etc).
ConclusionWe as humans are prone to develop umbilical hernia, depending on the symptoms, surgery can be performed in a planned manner using modern methods of Laparoscopic (key hole) surgery or the traditional method, both are safe. It is advisable to plan the surgery before complications can set in. The family practitioner can assess and diagnose the hernia, and then one can consult the surgeon for further appropriate management.