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ACS

Adult Umbilical Hernia

An umbilical hernia occurs when tissue bulges out through an opening in the muscles on the abdomen near the navel or belly button (umbilicus). About 10% of abdominal hernias are umbilical hernias.

Adult Umbilical Hernia

Common Symptoms

  • Visible bulge on the abdomen, especially when coughing or straining
  • Pain or pressure at the hernia site
  • Increasing sharp abdominal pain and vomiting can mean that the hernia is strangulated. This
    is a surgical emergency and immediate treatment is needed.

Treatment Options

Surgical Procedure

Open Hernia Repair

An incision is made near the site. Your surgeon will repair the hernia with mesh or by suturing (sewing) the muscle layer closed.

Laparoscopic Hernia Repair

The hernia is repaired with mesh or sutures inserted through instruments placed into small incisions in the abdomen.

Non-Surgical Treatment

Watchful Waiting

You may be able to wait to repair umbilical hernias that are very small, reducible (can be pushed back in) and not uncomfortable.3 If your hernia is not surgically repaired, there is a 4% risk that it can strangulate within the next five years. This means that your intestines can be squeezed in the hernia pouch with the blood supply cut off. In this case you will need emergency surgery.

adult-umbilical-hernia-graphic-2.png

Benefits and Risks of Your Operation

Benefits

An operation is the only way to repair a hernia. You can return to your normal activities and in most cases will not have further discomfort.

Risks of not Having an Operation

Your hernia may cause pain and increase in size. If your intestine becomes squeezed in the hernia pouch, you will have sudden pain, vomiting, and require an immediate operation.

Possible Risks

Possible risks include:

  • Return of the hernia
  • Infection
  • Injury to the bladder, blood vessels, intestines, or nerves
  • Continued pain at the hernia site

Expectations

Before your operation—Evaluation may include blood tests, urinalysis, and ultrasound. Your surgeon and anesthesia provider will discuss your health history, home medications, and pain control options.

The day of your operation—You will not eat or drink for six hours before the operation. Most often, you will take your normal medication with a sip of water. You will need someone to drive you home.

Your recovery—For a simple repair, you may go home the same day. You will need to stay longer for complex repairs.4

Call your surgeon if you have:

  • Severe pain
  • Stomach cramping
  • Chills or a high fever (over 101°F or 38.3°C)
  • Odor or increased drainage from your incision
  • No bowel movements for three days

Keeping You Informed

Who Gets an Umbilical Hernia?

Ten percent of all hernias in adults are umbilical.5 They are three times more common in women due to pregnancy. They are equally as common in men and women over 60 years as abdominal muscles start to weaken.6

Pregnancy Considerations

Pregnancy may cause a hernia because of increased abdominal pressure. Hernia among pregnancies is 0.08%. If the hernia is not complicated, but symptomatic, it should be repaired. If the hernia is incarcerated or strangulated it will require an emergency repair.7

The Condition

An umbilical hernia occurs when part of the intestine or fatty tissue bulges through the muscle near the belly button (navel, umbilicus). Most adult umbilical hernias are caused by increased abdominal pressure against a weak abdominal wall (acquired hernia).

A reducible hernia can be pushed back into the opening or decrease in size when lying flat. When intestine or abdominal tissue fills the hernia sac and cannot be pushed back, it is irreducible or incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is cut off. This is a surgical emergency and a bowel resection may also be needed.8

Risk Factors
  • Older age—muscles become weaker
  • Overweight and obesity—increased weight places pressure on abdominal muscle
  • Chronic straining
  • Family history
  • Ascites: excess fluid in the space between the tissues lining the abdomen and abdominal organs; may be due to alcoholism
  • Pregnancy, particularly multiple pregnancies
Common Tests

History and Physical Exam

Checks for the presence of bulge Umbilical hernias are usually diagnosed by clinical examination only. Imaging by ultrasound or CT scan can be considered if clinical examination is unsure.

Additional Tests (see Glossary)

  • Ultrasound
  • Computerized tomography (CT) scan
  • Blood tests
  • Urinalysis
  • Electrocardiogram (ECG)–for patients over 45 or if high risk of heart problems
Surgical Treatment

The type of operation depends on hernia size and location, and if it is a repeat hernia (recurrence). Your health, age, and the surgeon’s expertise are also important. An operation is the only treatment for a hernia repair.

Your hernia can be repaired either as an open or laparoscopic approach. The repair can be done by using sutures only or adding a piece of mesh.

Open Hernia Repair

The surgeon makes an incision near the hernia site, and the bulging tissue is gently pushed back into the abdomen. Sutures or mesh are used to close the muscle.

For a suture-only repair: The hernia sac is removed. Then the tissue along the muscle edge is sewn together. The umbilicus is then fixed back
to the muscle. This procedure is often used for small defects.9

Hernioplasty/Open mesh repair: The hernia sac is removed. Mesh is placed beneath the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia. The mesh extends 3 to 4 cm beyond the edges of the hernia. Open mesh and laparoscopic repair for umbilical hernias do not differ in 30-day outcomes or in risk of recurrence.1

  • For all open repairs, the skin site is closed using sutures, staples, or surgical glue.
  • An open repair may be done with local anesthesia and sedation given through an IV.
  • Your surgeon may inject a local anesthetic around the hernia repair site to help control pain.
  • With complex or large hernias, small drains may be placed going from inside to the outside of the abdomen.

Laparoscopic Hernia Repair

Laparoscopic repair decreases the risk of wound complications and may be preferred for large (over 4 cm) umbilical hernias. Laparoscopic repair may be considered for medium-sized hernias in patients at high risk of wound infection.

The surgeon will make several small punctures or incisions in the abdomen. Ports or trocars (hollow tubes) are inserted into the openings. Surgical tools and a lighted camera are placed into the ports. The abdomen is inflated with carbon dioxide gas to make it easier for the surgeon to see the hernia. Mesh may be sutured or fixed with staples to the muscle around the hernia site. The port openings are closed with sutures, surgical clips, or glue.

Herniorrhaphy is the surgical repair of a hernia.

Hernioplasty is surgical repair of a hernia with mesh inserted to reinforce the weak area.

Keeping You Informed

Open vs. Laparoscopic Incisional Repair

There is no significant evidence on the best technique to repair an umbilical hernia. The type of repair may also depend on the size of the hernia.

  • Open mesh and laparoscopic repair for umbilical hernias do not differ in 30-day outcomes or in risk of recurrence. There is a slightly lower wound complication rate, including seromas, hematomas, and infection, with laparoscopic repair.1 Both types of operations have similar long- term results.
  • Open repairs can be done with local anesthesia instead of general anesthesia and are frequently done as outpatient procedures.
  • Strangulated hernias may have to be repaired as an open approach.
  • The use of mesh provides a stronger repair and decreases the rate of recurrence.
  • Suture repair will result in a small incision around the hernia site. Laparoscopic repairs usually have 3 to 4 smaller scars at the site of the entry ports.
Risks Based on the ACS Risk Calculator
Open and Laparoscopic Umbilical Hernia Surgery from the ACS Risk Calculator – March 30, 2022

Risks

Percent for Average Patient

Keeping You Informed

Wound Infection: Infection at the area of the incision or near the organ where the surgery was performed

Open 1.3%

Laparoscopic 0.6%

Smoking and obesity increase the risk of postoperative wound complications in general. Smoking cessation is advised for 4–6 weeks, and weight loss to BMI below 35 before elective umbilical repair.

Complications: Including surgical infections, breathing difficulties, blood clots, renal (kidney) complications, cardiac complications, and return to the operating room

Open 2.1%

Laparoscopic 2.6%

Complications related to general anesthesia and surgery may be higher in smokers, elderly and/or obese patients, and those with high blood pressure and breathing problems. Wound healing may also be decreased in smokers and those with diabetes and immune system disorders.

Pneumonia: Infection in the lungs

Open 0.1%

Laparoscopic 0.2%

Movement, deep breathing, and stopping smoking can help prevent respiratory infections.

Urinary tract infection: Infection of the bladder or kidneys

Open 0.2%

Laparoscopic 0.1%

Drinking fluids and catheter care decrease the risk of bladder infection.

Venous thrombosis: A blood clot in the legs that can travel to the lungs

Open 0.1%

Laparoscopic 0.1%

Longer surgery and bed rest increase the risk. Getting up, walking 5 to 6 times per day, and wearing support stockings reduce the risk.

Death

0%

Your surgical team is prepared for all emergency situations.

Risks from Outcomes Reported in the Last 10 years of Literature

Percent for Average Patient

Keeping You Informed

Immediate postoperative pain

The method of repair does not appear to cause significant difference in early post-operative pain.

There may be a feeling of tightness in your abdomen because the muscle has been pulled together. Your pain will be managed with nonsteroidal anti-inflammatory medications and by resting and avoiding straining or lifting.

Recurrence: A hernia can recur after the repair

Suture repairs 17%

Mesh repairs 2.3%13

The use of mesh or other type of patch repair appears to reduce the rate of recurrence.13 Ascites, liver disease, diabetes, obesity, and suture repair without mesh are associated with recurrence.12

Seroma: A collection of clear/yellow fluid

Hematoma: a collection of blood in the wound site or scrotum

Open & Laparoscopic

Suture repairs 50 of 1,000

Mesh repairs 60 of 1,0009

Seromas are the most common complication after umbilical hernia repair. Seromas can form around the former hernia site. Removal of fluid with a sterile needle may be required.

Hematomas are treated with anti-inflammatory medications, elevation, and rest.

The data have been averaged per 1,000 cases

The ACS Surgical Risk Calculator estimates the risk of an unfavorable outcome. Data is from a large number of patients who had a surgical procedure similar to this one. If you are healthy with no health problems, your risks may be below average. If you smoke, are obese, or have other health conditions, then your risk may be higher. This information is not intended to replace the advice of a doctor or health care provider. To check your risks, go to the ACS Risk Calculator.

The Day of Your Procedure

Get the details you need about common procedures and know what to expect before you or a loved one has surgery.

Recovery and Discharge

Access resources and information you need to optimize your recovery from surgery.

Safe Pain Management

Your surgical team wants to help you to safely and effectively manage any pain that you may have after surgery.

Surgery FAQ

Answers to common questions surgical patients have before, during, and after a procedure.

Glossary

Abdominal X ray: Checks for any loops of bowel or air-filled sacs.

Abdominal ultrasound: Sound waves are used to determine the location of deep structures in the body. A hand roller is placed on top of clear gel and rolled across the abdomen.

Ascites: Excess fluid in the space between the tissues lining the abdomen and abdominal organs; may be due to alcoholism or liver disease.

Advance directives: Documents signed by a competent person giving direction to health care providers about treatment choices.

Blood tests: Tests usually include a Chem-6 profile (sodium, potassium, chloride, carbon dioxide, blood urea nitrogen and creatinine) and complete blood count (red blood cell and white blood cell count).

Computerized tomography (CT) scan: A diagnostic test using X ray and a computer to create a detailed, three-dimensional picture of your abdomen. A CT scan normally takes about 15 minutes or less.

Electrocardiogram (ECG): Measures the rate and regularity of heartbeats, the size of the heart chambers and any damage to the heart.

General anesthesia: A treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery.

Hematoma: A collection of blood that has leaked into the tissues of the skin or in an organ, resulting from cutting in surgery or the blood’s inability to form a clot.

Incarceration: The protrusion or constriction of an organ through the wall of the cavity that normally contains it.

Local anesthesia: The loss of sensation only in the area of the body where an anesthetic drug is applied or injected.

Seroma: A collection of serous (clear/yellow) fluid.

Strangulation: Part of the intestine or fat is squeezed in the hernia sac, and blood supply to the tissue is cut off.

Urinalysis: A visual and chemical examination of the urine, most often used to screen for urinary tract infections and kidney disease.

DISCLAIMER

The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The ACS endeavors to provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The ACS makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.

Reviewed April 2016 by:
Nancy Strand, MPH, RN
Mark Malangoni, MD, FACS
Brian Heniford, MD, FACS

Revised April 2022:
Nancy Strand, MPH, RN

References

  1. Shankar DA, Itani KMF, O’Brien WJ, Sanchez VM. Factors Associated with Long-term Outcomes of Umbilical Hernia Repair. JAMA Surg. 2017;152(5):461-466. doi:10.1001/jamasurg.2016.5052
  2. Kokotovic D, Sjølander H, Gögenur I, Helgstrand F. Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe. Hernia 2016; 20: 281–287.
  3. Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. BJS Br J Surg. 2020;107(3):171-90.
  4. https://riskcalculator.facs.org/RiskCalculator/March 30, 2022.
  5. Coste AH, Jaafar S, Misra S, Parmely JD. Umbilical hernia. InStatPearls [Internet] 2019 Sep 29. StatPearls Publishing.
  6. Dabbas N, Adams K, Pearson K, Royle GT. Frequency of abdominal wall hernias: is classical teaching out of date? JRSM short reports. 2011 ;2(1):1-6.
  7. Kulacoglu H. Umbilical Hernia Repair and Pregnancy: Before, during, after…. Front Surg. 2018;5:1. Published 2018 Jan 29. doi:10.3389/fsurg.2018.00001
  8. Ozbagriacik M, Bas G, Basak F, et al. Management of strangulated abdominal wall hernias with mesh; early results. North Clin Istanb. 2015;2(1):26-32. Published 2015 Apr 24. doi:10.14744/nci.2015.03522.
  9. Hernia Repair Surgery. https://my.clevelandclinic.org/health/treatments/17967-hernia-repair-surgery. Accessed March 31, 2022.
  10. Helgstrand F. National results after ventral hernia repair. Dan Med J. 2016 Jul;63(7):B5258. PMID: 27399983.
  11. Kaufmann R, Halm JA, Eker HH, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised,
    double-blind, controlled, multicentre trial. Lancet.
    2018;391(10123):860–9. https://doi.org/10.1016/S0140-
    6736(18)30298-8.
  12. Shaukat N, Jaleel F, Jawaid M, Zulfiqar I. Is there difference in chronic pain after Suture and Stapler fixation method of mesh in Ventral Hernia? Is stapler fixation method quicker? A randomized controlled trial. Pak J Med Sci. 2018;34(1):175-178. doi:10.12669/pjms.341.
  13. Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. J Am Med Assoc 2016;316:1575-82.