Hernia Repair, Umbilical

Introduction

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

An umbilical hernia appears as a lump near the navel (bellybutton) that may get bigger when your child laughs, coughs, cries or goes to the toilet. It may shrink when your child is relaxed or lying down.

Umbilical hernias are very common and affect 10% of infants and young children. They are especially common in babies who are born prematurely.

An umbilical hernia is not painful. In 85% of cases, the umbilical hernia goes back in and the muscles reseal before the child's first birthday.

What causes an umbilical hernia?

During pregnancy, the umbilical cord passes through an opening in the baby's abdominal wall. This opening should close before birth, but in some cases the muscles do not seal completely.

This leaves a weak spot in the surrounding muscle wall (abdominal wall). An umbilical hernia can develop when fatty tissue or a part of the bowel pokes through into an area near the navel.

Occasionally, an umbilical hernia can develop in adults. The following factors make this more likely to happen:

Being overweight
Lifting heavy objects
Having a persistent cough
Having a multiple pregnancy

These pages focus on umbilical hernia repair in children. For information on other types of hernia, see:

Umbilical hernia treatment

If the umbilical hernia is large or has not disappeared by the time the child reaches four years old, you may consider an umbilical hernia repair.

Dr. B C Shah will usually advise you to wait for your child to reach this age before considering an operation as it is not an essential procedure unless there are complications.

In less than 1% of cases, the bit of bowel can get stuck outside the abdomen. This can cause pain and vomiting, and could damage your child's bowel. In these cases, immediate surgery will be recommended to prevent bowel damage.

Repairing the umbilical hernia

An umbilical hernia repair is a routine and simple procedure to push the bulge back into place and strengthen the abdominal wall. General anaesthetic will be used so that your child does not feel any pain during the operation, which should take about 30 minutes.

The weak spot is usually closed with stitches, but if the hernia is large, mesh may be used to strengthen the area. After the operation, the bulge will disappear and the belly button should look normal.

When recovering from an umbilical hernia repair, your child should be able to go home the same day but may feel a bit sore and uncomfortable. They will need to limit their activity for a few days and take time off school. Young children may be a bit tearful and sleepy, but this is normal.

Are there any risks?

Complications from an umbilical hernia repair are rare but can include:

The wound becoming infected and needing antibiotics
The hernia returning
Feeling sick, a headache or numbness in the legs a few hours after the operation

If the hernia was large, some excess skin may remain after the operation, but this will usually settle as your child grows up.

How it is performed

Umbilical hernia repair is a fairly quick and simple operation, and your child will usually be able to go home on the same day.

You will be asked to bring your child into the day surgery (outpatients) section of the hospital and not to give them food for four to six hours before. They can have water for up to two hours before surgery.

At the hospital, you will meet the nurse, anaesthetist (specialist who will put your child to sleep) and Dr. B C Shah. Your child will be given a general anaesthetic while you are there. As soon as they are asleep, you can leave.

The operation

Dr. B C Shah will make a small cut (2–3cm) at the base of your child's belly button, and pushes the fatty lump or loop of bowel back into the abdomen.

Muscle layers are stitched over the weak spot in the wall of the abdomen to strengthen it. In some cases, a mesh may be used to strengthen the area if the hernia was particularly large.

The wound on the surface of the skin is closed with dissolvable stitches or special glue. Sometimes, a pressure dressing is applied, which stays on for four to five days.

The operation takes 20–30 minutes, but your child will be away from the ward for around one hour. You will be taken to the recovery room as soon as your child wakes up, so you can be with them on their way back to the ward.

Recovering from surgery

Your child will not feel any pain while their hernia is being repaired, but may feel sore and uncomfortable for a few days afterwards.

Local anaesthetic (which numbs the area) will be injected before the end of the operation to reduce the pain, and painkillers will also be given after the operation.

After the operation, your child may be tearful and sleepy, and demand extra attention as a result of the general anaesthetic. This is normal and will pass.

Most children can go home a few hours after surgery. They must have something to eat and drink first, and go to the toilet. Your child may need to stay in hospital overnight for monitoring if:

They have other medical problems
They vomit regularly after the operation and cannot keep down any food or drink

At home

Your child may have bruising and tenderness around the wound. This is normal and will settle within around seven days. You can give them painkillers such as paracetamol and ibuprofen (children under 16 must not be given aspirin).

Try to keep the wound dry for five to seven days. Your child can have a shower but they should avoid swimming and bathing.

Loose clothing may help reduce any discomfort your child has, but they should be able to wear trousers or a skirt as normal.

Most children naturally limit their own activity for a few days until they feel comfortable and well.