Umbilical Hernia Surgery (Umbilical Hernioplasty)

Why Is Umbilical Hernia Surgery Done?

The surgery may be recommended to repair an umbilical hernia in children if the hernia: 

• does not go away on its own by the time the child is three or four years of age
• becomes incarcerated or strangulated (abdominal tissue or intestine is stuck or trapped inside the hernia’s sac)
• becomes larger than two cm in size

                                                                                                Umbilical Hernia in Children

Most adults with an umbilical hernia should undergo surgery since the hernia is unlikely to heal on its own as they become older and the risk of complications increases.

Symptoms of an umbilical hernia include:

• Umbilical hernia appears as a soft bulge under the skin of the abdomen of your child. This bulge appears when parts of the intestine start to push through the weakened abdominal wall. It may become more noticeable when your child is coughing or lifting something heavy. 
• An umbilical hernia is usually painless. However, if it becomes incarcerated or strangulated, it may cause nausea, abdominal pain, and vomiting.

When to See a Doctor?

Children with an umbilical hernia should visit a doctor due to the risk of complications. Immediate medical assistance is required if you or your child have an umbilical hernia and experience the following symptoms:

• Reddish or purplish discolouration of the skin around the hernia
• Constipation or the inability to pass stool
• Presence of blood in stool
• Vomiting and nausea
• Abrupt onset of abdominal pain that soon worsens
• Pain on pressing the hernia

What to Expect if You Delay Surgery?

Delaying the surgery can lead to the following complications:

• Incarcerated hernia: When herniated tissue becomes stuck in the weak spot in the abdominal wall and cannot be easily pushed back into place, it is called an incarcerated hernia
• Strangulation: Strangulation happens when the blood flow to the bowel tissues is cut off as the bowels are trapped in the herniated portion of the abdominal wall. This results in tissue death and can turn into a life-threatening event. A strangulated hernia demands immediate medical attention to restore blood supply to the strangulated bowel tissue

The umbilical hernia repair surgery can be done by two methods:

• Open surgery
• Laparoscopic surgery
   

Open Surgery:

Open Hernia Repair Surgery is done through one single incision (cut) on the abdomen. The surgery takes about 30-45 minutes to complete.

• You or your child will be administered general anaesthesia (to induce sleep and relax the muscles).
• The surgeon will make an incision of two to three cm at the base of your belly button.
• The surgeon will then locate the hernia sac that contains the protruding intestine.
• The surgeon will reposition the intestine beneath the muscle wall.
• The weak abdominal muscles will then be sewn together to prevent the occurrence of another hernia. When the hernia is large or if you are an adult, the weak spot on the abdominal wall may be reinforced with a specific mesh patch instead.
• After that, the surgeon will stitch up the wound on the skin's surface
   

Laparoscopic Surgery:

Laparoscopic Hernia Repair is done through three to five small incisions on the abdomen with fewer chances of post-surgery complications such as seromas (accumulation of clear or yellow fluid), haematomas (collection of blood), and infection. It is done as follows:

• Smaller incisions around three-five in number are made during this surgery.
• The incisions will be filled with hollow tubes (ports or trocars).
• A laparoscope is inserted (a narrow tube with a tiny video camera attached to it) through one of the ports.
• Carbon Dioxide may be used to inflate the abdomen so that enough space is created
• The mesh will be sutured or stapled to the muscle surrounding the hernia. 

Surgical clips, sutures, or an adhesive will be used to close the incisions

 

What to Plan Before Surgery?

Preoperative examination

• Please inform your anaesthetist of any allergies, lung disease, neurological diseases such as epilepsy, endocrine illness like diabetes or thyroid problem, or a loose tooth etc.

Diet

• Fasting will be required for at least 6-8 hours before the procedure

If you or your child need to take specific medications on the day of surgery, take them with a sip of water.

Medications

• Keep your doctor if you or your child is on any supplements or medications that you or your child are taking currently.
• In the case of adults, avoid using aspirin and salicylate-containing painkillers at least a week prior to the surgery, as this can increase your risk of bleeding.

If you have been using blood-thinning medicines, you will need to discontinue them temporarily to prevent the risk of bleeding

Miscellaneous

• Smoking increases the likelihood of a hernia recurrence as well as the risk of infection. Therefore, you may be asked to stop smoking at least four to six weeks before your surgery to improve the results.
• Showering the night before or on the morning of the procedure is recommended.
• Make sure you or your child sleep well the night before the surgery.
• If the surgery requires you or your child to say at the hospital, bring everything you will need for the duration of your stay.

Plan for someone to drive you home after the surgery. You will be unable to drive or get home on your own due to the effects of anaesthesia and pain medication.

On the Day of Surgery

• The anaesthetist will go through the pre-anaesthesia check-up reports to confirm that you or your child are fit for surgery & a consent form will be signed
• You or your child will be provided with an identity bracelet and allergy bracelet on your wrist, which will contain your name and the name of the hospital.
• The healthcare staff will ask you to remove your clothing, jewellery, glasses, hairpins, contact lenses or any objects that may interfere with the surgery.
• You will receive a hospital gown to wear & shifted to the operation theatre

The healthcare staff will place a soft, thin tube called an intravenous line into a vein in your or your child's hand or arm so that they can give medicines directly into the blood vessel.

 

What to Expect During Surgery?

• You will sleep throughout the procedure as you will be under general anaesthesia
• Local anaesthesia is sometimes used instead of general anaesthesia especially in adults with a minor hernia. In this case or are not physically fit to have general anaesthesia. Here, only the area being operated on will be numbed, but you will remain awake.
• Iodine, alcohol, or chlorhexidine-based solutions are used to clean the surgical site before starting the procedure.
• Once the chosen solution has dried, the surgeon will cover the surgical field with either iodine-impregnated sticky drapes or incise drapes

What to Expect After Surgery?

At Hospital:

• The patient will be shifted to the recovery room & vitals will be monitored.
• You will be allowed to drink a little quantity of liquids once you wake up from anaesthesia. If you are not unwell, you can start having your regular food.
• Once awake, your child may be drowsy or cry a lot, requiring extra attention. This is a common occurrence that will pass.
• The surgical site might be sore and uncomfortable after the operation. Painkillers will be provided to you to help you deal with the pain.

You will be able to go home on the same day. However, people with other medical problems or those who have frequent vomiting and are unable to keep drinks or food down will need to spend the night at the hospital.

At Home:

• Use a sponge bath instead of a tub bath for the first few days following surgery.
• The doctor will give certain medications after the surgery to help with the pain. Take them as per the doctor's instructions. 
• Increase your activity level gradually. For example, in the initial few days, to avoid clot formation, get up and move every hour or so.
• You should be able to return to work in two to three days after your surgery. However, avoid heavy lifting and intense activities for about four to six weeks.
• Constipation might create pain around your wound if you strain during bowel movements. Therefore, make sure that you or your child drink plenty of fluids and eat a high-fibre diet to reduce the risk of constipation. 
• Avoid wearing tight-fitting clothes as they can rub against the incision site and hamper your healing process.
• Avoid exposing the wound area to the sun as new skin is prone to burning.
• Wash your hands before and after you touch the incision site.
• If your child has had the surgery, it is advisable to not send them to school for about a week after the surgery to allow them to heal.
• When it comes to changing your bandages, follow your surgeon's recommendations.
  
  
  
  
  
  
  
  
   

When to See a Doctor?

Follow-up: You should visit your surgeon two weeks after the surgery to confirm that your or your child’s pain is under control and there are no signs of infection. Your surgeon may suggest a follow-up appointment depending on your progress.

Contact your doctor in case you or your child experience any of the following symptoms:

• Bleeding from the incision site
• Foul-smelling discharge from the incision site
• Temperature higher than 38°C for an extended period
• Increased abdominal swelling or discomfort that isn’t alleviated by painkillers
• Consistent nausea or vomiting, as well as chills
• Increasing redness around your incisions
• Inability to pass urine