Home/Patient information/Umbilical hernia repair
Patient information
An umbilical hernia is a common problem. This page explains when a repair is advisable, how it is performed and what to expect afterwards.
An umbilical hernia presents as a small swelling in or around the umbilicus (belly button). It is usually noticed incidentally and is often small and painless, but can gradually increase in size. Often the swelling disappears when you lie flat, but on other occasions it is constantly present.
The hernia is due to a defect in the midline of the abdominal wall, where the wall is thin and consists of skin, fat and fibrous tissue (fascia) rather than muscle. In every person there is a tiny defect in this layer at the umbilicus, where the umbilical cord once passed into the abdomen.
Most umbilical hernias run a benign course and do not cause pain. Some increase in size, and when they become permanently present there is a small risk of complications. Usually the defect is small and the intestine cannot become trapped. However, it is common for some fat to become fixed within the hernia. This fat can occasionally lose its blood supply, becoming painful and hard, and an infection may develop. This is not common, but it is unpredictable.
If the hernia is small and not causing pain, it is reasonable to take a conservative approach and not to intervene unless it gets bigger or causes symptoms. If the hernia is uncomfortable, painful or restricts exercise, an operation to repair it is appropriate. An operation is usually advised if the hernia and defect are large, the contents cannot be pushed back, and especially if bowel is present within the hernial sac.
The standard operation for most umbilical hernias with a small defect is an open repair under general anaesthetic. A small curved incision is made beneath the umbilicus and the hernial sac is gently separated from the underside of the umbilical skin. The contents are returned to the abdominal cavity and the defect is repaired with either permanent sutures or a small disc of mesh placed beneath the abdominal wall.
For very small defects a suture repair is the simplest and best technique. To reduce recurrence rates, Mr Crinnion now uses a mesh suture called Duramesh, which gives the benefit of a mesh. If the defect is larger than about 2cm, the best method is to reinforce the abdominal wall with a mesh, which reduces the rate of recurrence.
The operation leaves a small curved scar just beneath the umbilicus which generally almost disappears, although this takes several months. The area will be swollen after the operation, but as this settles a good cosmetic result can be expected.
The published risk of recurrence after umbilical hernia repair is 2–5%. Avoid heavy abdominal exercise or lifting for a few weeks to reduce the risk.
Wound infection occurs in around 1–2% of cases. Infection of mesh, if used, is more serious but rare (less than 1 in 500).
Rarely, if the umbilical skin was very stretched, the wound edge may lose its blood supply and heal slowly. This delays healing but has no long-term consequences; loss of the umbilicus is very unlikely.
There will be some pain and soreness for at least the first 48 hours, eased by regular painkillers. Although you will be given codeine to take home, regular paracetamol (2 tablets four times a day) and ibuprofen (2 tablets three times a day with food) are recommended if they are sufficient. If you need codeine, it is very important to take the laxative that is also provided. The severity of pain varies, and more pain than expected does not usually mean there is a complication.
After the first 24–48 hours the area should feel more comfortable, and you can take part in normal activities and walk freely. You may drive after about 5–7 days, or sooner if the area is comfortable.
The wound is closed with absorbable sutures covered with a waterproof dressing or skin glue, so you can shower the day after the operation. An appointment will be made around 2 weeks after surgery to check the wound and advise on exercise. Generally you can run and cycle after 10–14 days and swim once the wound has fully healed after 2–3 weeks. Ease yourself gradually into core exercises, particularly lifting weights.
You need not worry about straining or normal activities shortly after the operation – these will not increase the chance of recurrence. If you develop worsening pain or inflammation of the wound after 4 to 5 days, please contact Mr Crinnion’s office.
On this page
Please contact Mr Crinnion’s secretary, Maxine Levene.
Tel: 0787 028 0264
Email: enquiries@jamescrinnion.co.uk
Related information
Why gallstones cause problems and what to expect from keyhole surgery.
Read the information
Keyhole repair of inguinal hernias with an enhanced recovery.
Read the information
The most common hernia operation, often under local anaesthetic.
Read the information
Mr Crinnion’s office is happy to help before and after your procedure.