• 12 SEP 13
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    An umbilical hernia is an outward bulging of the abdominal lining or part of the abdominal organ through the area around the belly button.

    Causes, incidence, and risk factors

    An umbilical hernia in an infant occurs when the muscle through which blood vessels pass to feed the developing fetus doesn’t close completely, for adults, the closed umbilicus gives way under pressure.

    Umbilical hernias are common in infants. Most umbilical hernias are not related to disease. Umbilical hernias are fairly common in adults. They are seen more in overweight people and in women, especially after pregnancy. They tend to get bigger over time.

    Prevention

    There is no known way to prevent an umbilical hernia. Taping or “strapping” an umbilical hernia will not make it go away.

    Symptoms

    A hernia can vary in width from less than 1 centimeter to more than 5 centimeters.

    There is a soft swelling over the belly button that often bulges when the baby sits up, cries, or strains. The bulge may be flat when the infant lies on the back and is quiet.

    Signs and tests

    The doctor can find the hernia during a physical exam.

    Treatment

    Usually, no treatment is needed unless the hernia continues past age 3 or 4. In very rare cases, bowel or other tissue can bulge out and lose its blood supply (become strangulated). This is an emergency needing surgery.

    Definition of Umbilical hernia repair:

    Umbilical hernia repair is surgery to repair an umbilical hernia. An umbilical hernia is a sac (pouch) formed from the inner lining of your belly (abdominal cavity) that pushes through a hole in the abdominal wall at the belly button.

    Description:

    Usually the surgial procedures are performed under local aesthesia.

    Your surgeon will make a surgical cut under your belly button.

    • Your surgeon will find your hernia and separate it from the tissues around it. Then your surgeon will gently push the contents of the intestine back into the abdomen. The surgeon will only cut the intestines if they have been damaged.
    • Strong stitches will be used to repair the hole or weak spot caused by the umbilical hernia.
    • Your surgeon may also lay a piece of mesh over the weak area (usually not in children) to make it stronger.

    Umbilical hernia can also be repaired using a laparoscope, a thin, lighted tube that lets the doctor see inside your belly. The laparoscope will be inserted through one of the cuts and instruments will be inserted through the other cuts.

    When the Procedure Is Performed:

    Children:

    Umbilical hernias are fairly common. A hernia at birth will push the belly button out. It shows more when a baby cries because the pressure from crying makes the hernia bulge out more.

    In infants, the problem is not usually treated with surgery. Most of the time, the umbilical hernia shrinks and closes on its own by the time a child is 3 or 4 years old.

    Umbilical hernia repair may be needed in children for these reasons:

    • The hernia is painful and stuck in the bulging position.
    • Blood supply is affected.
    • The hernia has not closed by age 5 or 6.
    • The defect is very large or unacceptable to parents because of how it makes their child look. Even in these cases, the doctor may suggest waiting until your child is 5 or 6 to see if the hernia closes on its own.

    Adults:

    Smaller hernias with no symptoms sometimes can be watched. Surgery may pose greater risks for patients with serious medical problems.

    Without surgery, there is a risk that some fat or part of the intestine will get stuck (incarcerated) in the hernia and become impossible to push back in. This is usually painful. If the blood supply to this area is cut off (strangulation), urgent surgery is needed. You may experience nausea or vomiting, and the bulging area may turn blue or a darker color.

    To avoid this problem, surgeons often recommend repairing the umbilical hernia in adults. Surgery is also used for hernias that are getting larger or are painful. Surgery secures the weakened abdominal wall tissue (fascia) and closes any holes.

    Get medical care right away if you have a hernia that does not get smaller when you are lying down or that you cannot push back in.

    Prognosis

    Most umbilical hernias get better without treatment by the time the child is 3 – 4 years old. Those that do not close may need surgery. Umbilical hernias are usually painless. In adults, surgery is usually needed to solve the condition.

    Complications

    Strangulation of bowel tissue is rare but serious, and needs immediate surgery.

    All hernias need medical attention, diagnose and, if the case, surgical treatment.

    Eduard Ursuleanu, General Surgeon

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