An umbilical hernia occurs when part of your intestine bulges through the opening in your abdominal muscles near your bellybutton (navel). Umbilical hernias are common and typically harmless. Umbilical hernias are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries, causing the belly button to protrude. This is a classic sign of an umbilical hernia.
Children's umbilical hernias often close on their own in the first two years of life, though some remain open into the fifth year or longer.
Umbilical hernias that appear during adulthood are more likely to need surgical repair and manifest as a protruding belly button. 10% of adult abdominal hernias are umbilical.
Causes of an Umbilical Hernia
During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdominal wall, an umbilical hernia may appear at birth or later in life. Umbilical Hernias are most commonly seen in premature infants or babies with low birth weights, affecting both genders equally.
In adults, too much abdominal pressure contributes to umbilical hernias and the belly button exhibits a large protrusion. Causes of increased pressure in the abdomen include:
- Obesity
- Heredity
- Multiple pregnancies
- Previous abdominal surgery
- Fluid in the abdominal cavity
Weakened muscles
Ascites, or excess fluid in the space between the tissues lining the abdomen & organs
- Long-term peritoneal dialysis to treat kidney failure
Symptoms of an Umbilical Hernia
An umbilical hernia creates a soft swelling or bulge near the navel. In babies who have an umbilical hernia, the bulge may be visible only when they cry, cough or strain. Umbilical hernias in children are usually painless, however, if a baby appears in pain, begins to vomit or the hernia begins to discolor, medical attention is necessary. Umbilical hernias that appear during adulthood may cause abdominal discomfort, and follow similar guidelines for surgical intervention.
In addition to inguinal hernias in women that can be misdiagnosed as fibroids, ovarian cysts, or endometriosis, women are also prone to umbilical hernias near the belly button, especially with multiple pregnancies. A hearty laugh accompanied by pain can be a hidden sign of this type of hernia.
Complications of an umbilical hernia are rare, and most often occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of the trapped intestine and can lead to abdominal pain and tissue damage. If the trapped portion of the intestine is completely cut off from the blood supply, it can lead to tissue death.
Infection may spread throughout the abdominal cavity, causing a life-threatening situation. Adults with umbilical hernias are somewhat more likely to experience a blockage of the intestines, than infants. Emergency surgery is typically required to treat these complications.
Robotically-Assisted Umbilical Hernia Repair (Herniorrhaphy or Hernioplasty) with The Da Vinci® Robotic Surgical System
Surgical robotics for minimally invasive surgery
As a Board-Certified General Surgeon, Dr. David W. Ford operates with a minimally invasive robotic system to repair Umibilical hernias. This minimally invasive approach only requires one or a few small incisions that doctors use to insert surgical equipment and a camera for viewing.
Robotically-assisted Umbilical Hernia surgery utilizes an advanced robotic platform that is not autonomous but is controlled by the surgeon who is seated in the operating room and operates via the Surgeon Console that controls the Patient Cart’s robotic devices, including various surgical instruments and a camera. The da Vinci Surgical System allows surgeons to perform minimally invasive hernia repairs with clinically supported precision and accuracy. Robotically assisted surgery uses a laparoscope (a thin lighted tube with a camera on the tip) that is inserted through one of several small incisions, made away from where the hernia has occurred. The images gathered from the laparoscope’s camera are magnified, high-definition 3D, which are sent to a monitor that Dr. David W. Ford uses to guide the surgical system during the operation. If needed, the abdomen can be inflated with a harmless gas (carbon dioxide), which creates space to allow the doctor to view the inside of the body.
After the intestines or other tissues have been pushed back in, a surgical mesh material is usually inserted to strengthen the weakened area in the abdominal wall. After the procedure is completed, the small incisions in the abdomen are closed with a stitch or two or with surgical tape. While robotic surgery is preferred for the removal of smaller umbilical hernias or repair of weak areas, it can now also be used to reconstruct the abdominal wall. Dr. David W. Ford’s use of the state-of-the-art da Vinci Surgical System in his robotically assisted Umbilical hernia repair surgeries has allowed him to set an exceedingly high standard of expertise that can combine this method with traditional Open Surgery if required. The surgery may only take 30-45 minutes depending on the situation.
Many robotically-assisted surgical systems are FDA approved and in use today. However, many are specially designed for specific organs, procedures, or conditions, such as lung or pulmonary surgeries or knee and other extremity replacement surgeries. The da Vinci Robotic Surgical System is the premier system specialized in hernia repair surgery. Dr. David W. Ford is not only an expert board-certified surgeon but also certified in the use of this leading-edge technology.
This robotic platform offers Dr. David W. Ford fully wristed instruments and a 3D high-definition camera with 10x magnification. As a result, the repair can be done with more precision, and complex hernias can be fixed with small incisions. Furthermore, the robot does not get tired, and Dr. Ford sits during surgery, so there is less surgeon fatigue. For the patient, this translates into quicker recovery, less pain, and fewer complications. This is the preferred approach for medium to large hernias and many umbilical hernias as it combines the best of open and laparoscopic surgeries. Also, Dr. Ford is more likely to be able to sandwich the mesh between layers of the abdominal wall to keep the mesh from coming into contact with the intestines.
Other benefits of robotic hernia surgery include:
- Access to clear three-dimensional images (unlike laparoscopic surgery’s two-dimensional images) of the inside of the abdomen for more precise surgery.
- Dr. Ford can easily use stitches to sew tissue and meshes into the inside of the abdomen.
- The patient is left with smaller scars rather than one large incisional scar.
- The possibility of much less pain, faster recovery, and quicker return to normal diet and activities after surgery are observed, compared to all other types of hernia repair surgery.
Should robotically-assisted surgical laparoscopic surgery be recommended as part of treatment for your Umbilical hernia repair, Dr. David W. Ford and his team will have the best state-of-the-art technology at their disposal to usher in your recovery.
How The Da Vinci® Robotic Surgical System works
Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.
Surgeon Console
Patient Cart
The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.
A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.
Vision Cart
The vision cart makes communication possible between the components of the system possible, and supports the 3D High Definition vision system.
Open Umbilical Hernia Repair (Herniorrhaphy or Hernioplasty)
The traditional surgical method is employed when the hernia is extremely complex, and is most often used with inguinal or umbilical hernias. A complex hernia repair may require mesh removal, resection of the abdomen, or removal of extraneous skin or fat, and therefore is easier with open surgery.
The open surgery requires that a single 5-10 cm long, open incision be made in the abdomen just above or below the belly button, over the location where the hernia has occurred, and then the intestine or abdominal tissue is pushed back into place.
Synthetic mesh material is placed to reinforce this repair and reduce hernia recurrences, however, sutures to close the hernia may be all that is needed. The skin is usually closed with dissolvable stitches and glue. See below about the surgical mesh.
Non-Surgical Options:
- Conservative, watch & wait management is helpful for patients with minimal or no symptoms.
- The hernia itself should not limit your ability to engage in your usual daily activities.
Surgical Options:
Hernia repair involves an operation, with overall one of two main approaches:
- Mesh repair – the use of mesh to enhance the repair & provide further reinforcement
- Non-mesh repair – closing the abdominal defect with stitches, creating some tension
Safety of Surgical Mesh:
- There is a large volume of data on the outcome of various hernia operations and different types of mesh, and the use of mesh to repair the majority of hernias has been the preferred method in the US, UK, and worldwide for over 30 years.
- When surgeons themselves have hernias that require surgery, they opt for mesh repairs.
- Patient safety is a critical component, and therefore, different meshes used in surgery are tightly regulated in both the US and UK.
What is the “Gold Standard”?
- Using mesh has become the gold standard in hernia repairs – and has a lower recurrence rate.
- Many patients with hernias have tissue weakness and often do not hold stitches well, which may explain why non-mesh repairs have a higher failure/recurrence rate than with mesh.
- For the vast majority of patients, mesh poses little if any additional risk.
Risks of Mesh:
- Mesh is a foreign material, like synthetic implants, such as dentures, crowns, heart valves, etc.
- It is possible for mesh to become infected, but this is rare.
- Some patients develop chronic pain after surgery. There is no strong relationship with the use of mesh and chronic pain. Furthermore, non-mesh repairs can result in similar pain outcomes.
Post-operative Treatment of Umbilical Hernias will vary due to the repair surgical procedure chosen, the severity of the hernia, its location, and any complexities in either surgery or comorbidities of the patient. Usually, patients go home the same day after umbilical hernia surgery. Abdominal wall hernia repairs may require up to a two-day hospital stay due to the need for internal stitches or other complications. At first, you may need to rest in bed with your upper body raised on pillows, to help you breathe easier and lessen post-surgery hernia pain. Both cold and heat can help lessen some types of post-op pain.
After recovery, you can usually return to work or school within 2 to 3 days. You may be prescribed an Umbilical Hernia Support Belt be worn until the abdominal wall and new skin strengthens. You will not be able to lift anything over 10 pounds, climb, or do strenuous activity for 2 to 6 weeks following surgical repair of an umbilical hernia. Always wash your hands before and after touching near your incision site.
Complications are rare, but numbness, hernia reoccurrence, infection, bleeding, or blot clots from improper healing are the main culprit when or if they occur. Losing weight relieves excess pressure on the abdomen, which can prevent a hernia from developing, improve hernia symptoms, and avoid complications such as strangulation.
You may call or email with any problems, questions, or concerns below:
Prescription Refill Hours:
Monday – Thursday 8:30 AM – 4:30 PM
Friday before 2:00 PM
- Please call if you experience any of the following:
- Temperature greater than 101 degrees
- Incisions with increasing areas of redness, thick or colored discharge, worsening tenderness
- Nausea and vomiting or an inability to tolerate anything by mouth
- Progressively worsening pain
Pain
- Acetaminophen (Tylenol)
- 650mg to 1000mg every 6 – 8 hours for first 3 days, scheduled
- After 3 days, may continue as needed for pain
- Do not exceed 4000mg in 24 hours
- Avoid if history of hepatic (liver) impairment, alcohol abuse
- Non-Steroidal Anti-Inflammatories (NSAIDs), choose one:
- Ibuprofen (Advil, Motrin) 400mg by mouth every 6 – 8 hours, as needed
- Naproxen (Aleve) 440mg by mouth every 12 hours, as needed. Avoid if history of renal (kidney) impairment, or a history of coronary artery disease (CAD), hypertension.
- Avoid multiple NSAIDs at once (e.g. Ibuprofen + Naproxen)
- Narcotics and Opioids
- Oxycodone, Hydrocodone & combo pills are for severe breakthrough pain ONLY
- If a combo pill (e.g. Percocet, Lortab, Vicodin, Norco), do NOT take with Tylenol.
- Do not drive or operate machinery while taking narcotic pain medication.
- Narcotics can be habit-forming, have addiction potential, and cause constipation, so be careful – and use sparingly.
- Tramadol
- Tramadol (Ultram) is for severe breakthrough pain & often used in place of opioids
- It is not a true narcotic but can be habit-forming with long-term use.
- Avoid if history of seizures
- Simethicone
- Simethicone (GasX) 40 to 125 mg every 8 hours as needed for gas pain & bloating
- Do not exceed 500mg in 24 hours; this is sold over-the-counter
Hygiene
- You may shower and use soap and water on surgical site incisions, the day after surgery
- Keep dressing clean and dry for 24 hours, you may replace as needed for drainage
- Do not swim or soak; no hot tub, pool, beach, lake, etc. for at least 7 days
Constipation
- Post-operatively & within 2 days, should be having regular, soft bowel movements (BMs)
- Hydrate & drink plenty of water (8 –10 glasses per day)
- PEG 3350 (Miralax) 17g by mouth each day for BMs each day
Other alternative recommendations, as needed – Use at least one if have not had a BM for 2 days:
- Magnesium Hydroxide (Milk of Magnesia) 15 – 30 mL by mouth once a day, as needed
- Magnesium Citrate 200 – 300 mL by mouth once a day, as needed
- Docusate (Colace) 100mg by mouth twice a day, as needed
Activity
- Ambulate and increase activity as tolerated post-operatively
- Simply walking often improves mentation, decreases pain & bloating, and improves BMs
- Avoid heavy lifting (greater than 20 pounds) until follow-up after laparoscopic and open surgeries
- Avoid prolonged straining and strenuous activity until follow-up
- Wear your abdominal binder after hernia repair
- Resume all home medication as directed
Wound Care
- The raised, firm area called a healing ridge is normal, and should resolve over time
- Remove your dressings/bandages 2 days after surgery, unless told otherwise by Dr. Ford himself
- You may shower and use soap & water on surgical site incisions, the day after surgery