The navel marks the point at which the embryonic umbilical cord vessels emerge through the abdominal wall. If the abdominal wall does not fully form here during later growth, this weak point can develop into a hernial orifice.
The term umbilical hernia is used when abdominal contents pass through this weak point. Parts of the intestine can also be affected.
An umbilical hernia occurs about equally often in boys and girls. However, children with black skin are affected more frequently than children with white skin.
98 percent of umbilical hernias disappear on their own by the age of two. The risk of incarceration is very low in childhood. Therefore, there is generally no need (indication) for umbilical hernia surgery up to this age.
Umbilical hernias also occur in adults due to
occur relatively frequently. However, the affected adults usually have no symptoms.
Severely pronounced umbilical hernia in a newborn © Piman Khrutmuang | AdobeStock
An umbilical hernia is normal in newborns before the umbilical scar forms. Children with a very low birth weight in particular often develop an umbilical hernia. For example, two thirds of premature babies with a birth weight of less than 1500 grams develop an umbilical hernia.
In adults, all factors that lead to increased pressure in the abdomen are risk factors for an umbilical hernia. For example
an increased risk.
Another risk factor for an umbilical hernia is a familial predisposition to connective tissue weakness.
An umbilical hernia may or may not cause symptoms. Initially, the umbilical hernia is noticeable as a swelling and protrusion in the area of the navel. This protrusion can be pushed back into the abdominal cavity relatively easily.
However, the umbilical hernia may not immediately slide back into the abdominal cavity, especially if the baby cries a lot. However, the umbilical hernia can become larger over time, especially when standing up or standing, and especially
cause pain. The umbilical hernia can also remain visible when lying down and without pushing.
Sudden severe pain with fever, nausea and vomiting are an alarm sign that the intestine has become trapped. Other signs are when
A life-threatening intestinal obstruction can develop. The intestinal section may no longer be sufficiently supplied with blood and oxygen. The affected area threatens to die off, bacteria enter the abdominal cavity and the vascular system, and there is an acute danger to life.
In this case, surgery is required immediately.
Recognizable protrusion of an umbilical hernia on the abdomen of an adult male © fotoart-wallraf | AdobeStock
The soft protrusion directly on the navel usually allows the doctor to make a tentative diagnosis. By palpating the protrusion in the supine position, the doctor can usually feel the hernial orifice well. He can assess whether and how easily the contents of the hernia sac can be pushed back into the abdominal cavity.
Additional examinations may be necessary to assess the umbilical hernia more precisely. For example, the size of the umbilical hernia and the age and weight of the patient are important.
This primarily includes an ultrasound. Further instrumental examinations are not normally necessary.
A small umbilical hernia in infants and small children in particular often resolves spontaneously in the first few years of life. The umbilical hernia therefore rarely needs to be closed with an umbilical hernia operation.
Even an umbilical hernia that occurs during pregnancy often disappears on its own.
However, umbilical hernias with a hernial orifice of more than 1.5 cm in diameter rarely close again on their own.
There is no spontaneous healing of umbilical hernias in adults. There is also a risk of incarceration. Therefore, an umbilical hernia operation should be performed at an early stage for every symptomatic umbilical hernia in adults.
However, umbilical hernia surgery should also be considered at an early stage in the case of an asymptomatic umbilical hernia. In children, umbilical hernia surgery can usually be delayed until the age of 3 to 6. If the umbilical hernia enlarges or causes discomfort, an earlier operation is necessary.
In acute cases, i.e. if there is a risk of incarceration of the hernia, a hospital should be visited immediately. An umbilical hernia operation is then usually performed within a very short time. The following principle then applies: "The sun must neither rise nor set over the incarcerated umbilical hernia."
The surgical treatment of an umbilical hernia can be performed under local anesthesia in the case of a small umbilical hernia. If the umbilical hernia is larger, surgery is usually performed under general anesthesia.
In some cases, umbilical hernia surgery can be performed on an outpatient basis so that the patient can go home on the same day. However, in cases of incarceration or severe pre-existing conditions, the operation should be performed as an inpatient.
Before the operation, an anesthetist will inform the patient about the procedure and the risks of anesthesia. The day before the operation, the patient is given a mild laxative and thrombosis prophylaxis. A sedative is administered shortly before the operation.
Local anesthesia or general anesthesia is used for umbilical hernia surgery © Yakobchuk Olena | AdobeStock
The abdominal wall is opened with an arched incision around the navel. After the skin of the hernia sac has been detached, the contents of the hernia sac are then moved back into the abdominal cavity. If necessary, the hernia sac is also removed.
The surgeon then sutures the edges of the hernial orifice back together.
The procedure depends on the size of the umbilical hernia:
Today,small umbilical hernias are usually treated using a direct suture, i.e. the two edges are sutured together directly.
In the case of large gaps (usually from 2 cm), a plastic mesh is placed in or under the open area and connected with a muscle layer due to the increased risk of recurrence. Recurrence means that the disease can form again later.
This stabilizes the abdominal wall and makes it less likely that the umbilical hernia will recur. There are different methods of umbilical hernia surgery depending on the layer of the abdominal wall in which the mesh is inserted:
Depending on the size of the hernia and the age of the patient, the hernia gap is
is performed.
Closed umbilical hernia surgery
In closed surgery, the hernial orifice is accessed through the abdominal wall via laparoscopy (laparoscopic umbilical hernia surgery). The surgeon simply makes small incisions through which small instruments and a camera lens are inserted into the abdominal cavity.
This allows the abdominal cavity and the organs within it to be visualized. Using special instruments, the hernial orifice can be closed directly or a plastic mesh can be inserted into the abdominal wall.
Laparoscopic umbilical hernia surgery is a comfortable and gentle surgical procedure for the patient:
Open umbilical hernia surgery
In open umbilical hernia surgery, the hernia sac is exposed via a larger incision. The surgeon then pushes the contents of the hernia sac back into the abdominal cavity.
Today, the hernial orifice is usually closed by directly suturing the fascia (supporting fibrous layer of the abdominal wall) (umbilical hernia surgery according to Spitzy). Fascia duplication is used less frequently. In the case of larger umbilical hernias, stabilization of the hernial orifice closure using
is possible.
Operation according to Spitzy
In the case of a small umbilical hernia (hernial orifice < 2 cm), closure according to Spitzy is performed by suturing the edges of the hernia with a strong suture. Although this umbilical hernia operation is performed under general anesthesia, it is usually performed as an outpatient operation.
The shortness of the procedure, the minimal trauma (tissue injuries) and the very low complication rate are particularly advantageous.
However, due to the lack of reinforcement with a synthetic mesh, there is a slightly increased risk of a repeat fracture. The patient must also take it easy physically for several weeks until final healing.
Fascia duplication
In fascial doubling, the edges of the abdominal wall layers (fascia) are sutured (doubled) in an overlapping manner, which results in greater stability. This umbilical hernia operation is also known as the Mayo umbilical hernia operation.
However, the doubling of the fascia no longer plays a role in umbilical hernia surgery today due to the great tension that develops on the sutures of the abdominal wall. The problem is that this often leads to the recurrence of hernias.
Techniques with plastic mesh
The plastic mesh inserted via a closed or open umbilical hernia operation is usually made of polypropylene, which is very well tolerated. Due to the risk of adhesions, it does not come into direct contact with the intestinal loops. For this reason, polypropylene mesh with a layer that prevents adhesions has been available for some years.
The difference between the various methods of umbilical hernia surgery with plastic mesh is the position of the mesh within the abdominal wall. The most common procedure is umbilical hernia surgery using the sublay mesh technique (below the abdominal muscles). There is also the intraperitoneal onlay mesh technique (IPOM, position of the mesh between the intestine and peritoneum) and the inlay technique, in which the mesh is inserted into the hernia gap.
The results after umbilical hernia surgery are generally good. Recurrences usually only occur with larger defects. Complications are very rare in planned operations.
Umbilical hernia surgery can lead to
can occur.
If a mesh is used, the infection rate after umbilical hernia surgery is around 2 to 4 percent. Hematomas and especially seromas can also occur after umbilical hernia surgery with the use of a mesh. The accumulation of fluid disappears after around 2 to 6 weeks; in the case of large accumulations, the fluid is removed via a puncture.
Hardening may occur in the area of the operation and nerve damage may cause temporary or, in rare cases, permanent numbness. Occasionally, the patient also complains of restricted movement and pain in the abdominal area.
Normal food intake is possible after umbilical hernia surgery. The skin is usually glued or sutured intracutaneously with self-dissolving material, which is why showering is possible immediately.
After the after-effects of the operation have subsided, weight-bearing of up to 10 kg is possible. Heavy physical exertion should be avoided for a good 6 weeks.
