What is an Umbilical Hernia?
An umbilical hernia is a bulge of tissue (internal fat called omentum, pre-peritoneal fat or intestines) through an abnormal opening in the muscle at the level of the umbilicus or navel (belly button). About 8-10% of all abdominal hernias are umbilical hernias.The umbilicus has very little physiologic importance after birth. In utero, it serves as a channel that allows the blood to flow between the uterus and the placenta. An umbilical hernia is the most common umbilical problem that is encounter by a surgeon. Others include infection (omphalitis), polyps, omphalomesenteric remnants and granulomas. An umbilical hernia occurs when fat, intestines or sometimes fluid pushes through a defect in the muscles in the umbilical area. More than 80% of umbilical hernias present at birth will close spontaneously within the first 3 years of life. The incidence of umbilical hernias decreases with age and although there is high familial incidence, its not transmitted genetically through a define pattern.
Symptoms of an Umbilical Hernia
Patients with umbilical hernias usually have a visible bulge in the area that increases in size with coughing, straining, pushing, heavy lifting or any maneuver that increases the intra-abdominal pressure. Most of the times there is also pain or pressure at the hernia site. When the hernia is strangulated, sharp pain, redness of the surrounding skin, nausea, vomiting and intestinal obstruction can occur.
Diagnosis of an Umbilical Hernia
Most umbilical hernias are diagnosed on physical examination by an experienced physician or Hernia specialist. Sometimes with non-palpable hernias or in the obese patient additional tests are indicated to help in the diagnosis including ultrasound, CT scan of the abdomen and pelvis or MRI. Some patients might have additional small defects around the peri-umbilical area, usually above the umbilicus. Careful examination is required in order to find these additional defects.
A hernia is called a “reducible hernia” when the bulge can be pushed back into the abdomen. An incarcerated or a “non-reducible hernia” occurs when the contents inside the hernia sac cannot be pushed back into their normal anatomic position inside the abdomen. Incarcerated hernias can sometimes become “strangulated” when the blood supply to the organs that are entrapped (intestines or fat or other organs) becomes compromised and the tissue dies. This is a surgical emergency that requires immediate operation.
Treatment of Umbilical Hernias
Umbilical hernias can be repaired either via an open approach or a laparoscopic / robotic approach. With an open approach a small incision is made in the umbilical area usually in a semi-circular fashion and the hernia is repaired either using the placement of a prosthesis or mesh or using a “suture” technique, where no mesh is placed and the muscles and tissues are sutured together in order to close the defect. For laparoscopic and robotic approaches, three or four small incisions are made in the lateral part of the abdomen through which long instruments are placed and the hernia is repaired with mesh. At the Miami Hernia Center when we perform open repair of umbilical hernias with mesh, most of the time we place the mesh in the pre-peritoneal space, that way the mesh is not in contact with the intra-abdominal organs, decreasing the risk of complications.
Most open repairs of umbilical hernias can be done with local anesthesia and intravenous sedation. Sometimes general anesthesia is required depending on the patient’s conditions and the size of the hernia. For laparoscopic or robotic repair, general anesthesia is required.