What is an Umbilical Hernia?
An umbilical hernia is an opening in the tissue of the abdominal wall at the site of the belly button. Umbilical hernias result from the incomplete closure of the tissue where the umbilical cord entered the abdomen. A hernia often causes a small bulge within the belly button that enlarges when patients bear down with crying, straining or coughing. The bulge is caused by tissue, fluid or sometimes bowel that protrudes into the opening. The defect or opening in the abdominal wall can vary in size from 0.5 cm to 3-4 cm in diameter. The hernia size is determined by measurement of the opening at the abdominal wall, not by the size of the bulge.
What are the Indications for Surgery?
Although the need for surgery must be determined on an individual basis, the most common reasons to perform surgery include:
- Anyone who appears to have an incarcerated hernia. Incarceration describes the event when intestine gets trapped in the hernia opening and cannot be pushed back into the abdomen. This often produces a painful, firm, discolored bulge at the belly button and should be evaluated immediately. Incarceration rarely occurs in umbilical hernias.
- In a child over age 3, repair is necessary to avoid complications/symptoms later in life when abdominal pressure increases. Pregnancy, weight gain, and heavy lifting all increase pressure within the abdomen and can cause stretching of the abdominal wall. Hernias may enlarge, cause pain or become a cosmetic concern.
- Although most umbilical hernias close on their own before age 3, surgery may be indicated for children under age 3 if the hernia is large, proboscis (elongated) in appearance or causing symptoms. Even if a hernia is large and surgery seems inevitable, waiting can be beneficial for the hernia opening to get smaller and the muscle wall to get stronger.
What is the Surgical Procedure?
Repair of an umbilical hernia is done under general anesthesia, usually as a day surgery.
- A small incision is made directly below the belly button in the normal skin fold. The skin is folded back, the hernia sac is removed, and the opening in the tissue is sutured closed.
- The belly button remains intact and normal in appearance postoperatively. The sutures are buried and dissolve; therefore, there are no stitches to be removed. Skin glue is applied to the incision and should be kept dry for 48 hours. The skin around the umbilicus may appear loose for a period of time after the repair. As the child grows and the skin regains some of its elasticity, it will flatten. There are generally no activity restrictions after the repair.
Disclaimer: Your child's condition is unique. The information contained on this web site is not intended to substitute for advice from a doctor or nurse. If you are unsure about any aspect of your patient's care, please contact us at 303-839-6001, or talk to your pediatrician.
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