Umbilical/ Paraumbilical hernia
An umbilical hernia is a protusion directly at the ‘belly-button’ or navel. A hernia around the belly-button is commonly know as a para-umbilical hernia. Your surgeon will be able to distinguish between the two types of hernia, but there is no difference in the repair required.
Who commonly presents with it?
Umbilical herniae are commonly seen in newborn babies and young children. They are usually harmless and generally require no treatment. Childhood umbilical herniae generally disappear, as the child gets older. Adults generally present with paraumbilical hernias and are more common in patients who are overweight and in women especially after pregnancy, where they present with also a divarication ‘split’ in the rectus muscle above.
How does it present?
Umbilical hernia in adults can be noted and present with pain and are made worse by heavy lifting, straining or coughing. They are often painless and reducible. In some cases the umbilicus can present with a very painful irreducible lump. If there is a change in the overlying skin with redness or a purple discolouration, there may be 'unhappy' bowel or fat in the hernia with surgical repair advised and undertaken as an emergency (incarcerated/ strangulated). This can occur with both umbilical and paraumbilcal herniae as the actual defect is usually quite small.
What can be done?
An umbilical/ paraumbilical hernia in an adult if painful and irreducible is often offered repair. They have a tendency to become bigger and more unsightly over time, so in some cases surgery is recommended for such patients.
Surgery involves a small incision under or above the umbilicus (belly-button) with the majority of hernia requiring stitches only. In some case if the hernia is large (>2cm) a mesh is inserted and recommended to help reduce the risk of recurrence and strengthen the repair.
Surgery can be performed under a local or general anaesthesia and does not normally require overnight stay.
For larger (obese) patients a 'keyhole' laparoscopic approach is sometimes recommended. This avoids a slightly larger incision under the umbilicus as would be expected and allows a quicker recovery with the use of only three small incisions.
Your Surgeon will discuss all the options with you and together a decision will be made on which type of hernia repair will suit you best.
How long will your recovery take?
Recovery is very quick, with most patients being discharged the same day. Patients are encouraged to start mobilising immediately after surgery and refrain from lifting heavy objects for at least two weeks and heavy duty activity for a possible further month. A return to full regular activities is expected within 1 week. Keyhole surgery also has a quick recovery with lifting heavy objects advised against for at least one month.
What are the main risks of surgery?
Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection and a 1-2% risk of recurrence of the hernia as well as a risk of bowel and other organ complications. The keyhole repair has a risk of seroma formation (fluid build up), which is mainly managed by conservative measures (wait and watch policy).