An umbilical hernia occurs when part of the intestine or fatty tissue bulges through a defect near the belly button) umbilicus). Most umbilical hernia are as aresult of increased abdominal pressure causing the hernia to bulge out. About 10% of abdominal hernias are umbilical hernias.
The most common symptoms of an umbilical hernia are pain and discomfort, especially during coughing or strenuous activities that increase the intraabdominal pressure. If the hernia becomes stuck or “incarcerated” it can lead worsening pain and more serious problems. Once the hernia is incarcerated, the blood supply to whatever is in the hernia can be cut off, causing a “strangulated hernia”. This is a surgical emergency and should be treated immediately!
Surgery is the only treatment option for a hernia. The type of operation depends on hernia size and location, and if it is a repeat hernia (recurrence). Most umbilical hernias are small and repaired open. A small smiley shaped incision is made just underneath the bellybutton. The hernia contents are pushed back into their original position and the hole in the abdominal wall is closed. If the hole is small, I usually close it with sutures. If the hole is large I may use a patch to close the defect. The patch or “mesh” reduces the risk that the hernia will come back again.
I recommend the laparoscopic approach in patients with very large or recurrent hernias and in patients with an obese or protuberant abdomen. The operation usually involves 3 tiny incisions used to place a camera and instruments into the abdomen. Mesh is then placed from underneath and secured to the abdominal wall.