Background Information:

What are the other Names for the Procedure?

• Umbilical Herniorrhaphy
• Ventral Herniorrhaphy

What is the Umbilical Hernia Repair surgical procedure?

• An Umbilical Hernia Repair is a surgical procedure that involves closing or repairing an umbilical hernia
• Umbilical hernia is a defect in the abdominal wall in, or adjacent to, the umbilicus through which fat or intestine may protrude
• In general, a hernia refers to the protrusion of a tissue or organ through a structure that contains it, due to a defect or weak muscles at the region

What part of the Body does the Procedure involve?

An Umbilical Hernia Repair involves the umbilicus and the different layers of the abdominal wall.

Why is the Umbilical Hernia Repair surgical procedure Performed?

An Umbilical Hernia Repair is performed for the following reasons:

• Improve visual appearance
• Relieve pain
• Prevent the risk of incarceration and strangulation of the hernia

If the repair is not performed, then the hernia may reduce, or become irreducible, obstructed, or strangulated.

• A reducible hernia occurs, when a hernia can be pushed back into the abdomen, either spontaneously or with manipulation. This is the most common type of inguinal hernia and is usually painless
• An irreducible hernia occurs, when a hernia becomes stuck. This can cause pain and a feeling of illness
• An obstructed hernia occurs, when a part of the intestine enters the hernia sac and gets blocked causing an intestinal obstruction
• A strangulated hernia occurs, when a hernia blocks blood supply to part of the bowel. If the herniated bowel has its blood supply diminished because of pressure from other nearby organs or structures, the affected tissue can die and be invaded by bacteria. This is a life-threatening surgical emergency

What are some Alternative Choices for the Procedure?

• All reducible umbilical hernias, do not need to be repaired immediately
• However, in cases of incarceration/strangulation, they need to be repaired immediately; there are no real alternative choices to surgical repair, in such cases

What are the Recent Advances in the Procedure?

Minimally invasive (laparoscopic approach) is a recent advancement in Umbilical Hernia Repair.

What is the Cost of performing the Umbilical Hernia Repair surgical procedure?

The cost of Umbilical Hernia Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Umbilical Hernia Repair procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.nlm.nih.gov/medlineplus/ency/article/002935.htm

http://www.surgeryencyclopedia.com/St-Wr/Umbilical-Hernia-Repair.html

Prior to Umbilical Hernia Repair surgical procedure:

How is the Umbilical Hernia Repair surgical procedure Performed?

There are two kinds of Umbilical Hernia Repair: Open repair and laparoscopic repair

Open repair:

• An incision is made in the region of umbilicus
• The incision is deepened and the dissection performed, to identify the hernia sac
• The hernia sac is then separated from the tissues around it
• The sac, may or may not be opened, which is determined by the surgeon at the surgery
• In case of incarcerated and strangulated hernia, the sac is opened and contents are examined for viability
• The sac is then pushed back inside the abdominal cavity, or sometimes excised and the defect is identified
• The defect is then obliterated, either by approximation of the adjacent tissue with stitches, or by placement of prosthetic mesh
• In cases of strangulated hernia, where the bowel is not viable, bowel resection is performed and the remaining ends are attached together, to establish continuity
• Mesh is contraindicated in case of incarcerated or strangulated hernia, due to an increased risk of mesh infection

Laparoscopic repair:

• Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area that is farther away from the hernia
• A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen
• Other cannulas are inserted, which allow the surgeon to delicately push the contents of the hernia sac back into the abdominal cavity
• Once the contents are pushed back, the surgeon identifies the defect and covers it with a piece of prosthetic mesh
• Laparoscopic repair is not performed in cases of strangulated hernia, where the bowel viability is compromised

Where is the Procedure Performed?

An Umbilical Hernia Repair procedure is usually performed in an out-patient surgery center facility, or a hospital. Normally, the individual can go home, once the procedure is completed.

Who Performs the Procedure?

A general surgeon or a pediatric surgeon performs an Umbilical Hernia Repair procedure

How long will the Procedure take?

The procedure to repair an umbilical hernia, usually takes about an hour.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)

A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Umbilical Hernia Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Umbilical Hernia Repair surgical procedure?

Prior to an Umbilical Hernia Repair procedure, the patient may need to undergo certain tests, such as:

• Routine blood and urine analysis
• Abdominal x-ray
• Chest x-ray
• Electrocardiography (ECG)
• CT scan of the abdomen and pelvis

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is an Umbilical Hernia Repair?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Umbilical Hernia Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Injection of local anesthesia, injection of spinal anesthesia, or a general anesthesia is administered, prior to the procedure.

How much Blood will you lose, during the Procedure?

• The procedure requires only a small incision, hence the amount of blood loss is very minimal
• If the procedure is under laparoscopic (minimally-invasive) approach, there is little blood loss involved
• If complications arise during the procedure, it could lead to a further loss of blood

What are the possible Risks and Complications during the Umbilical Hernia Repair surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection in the surgical wound
• Formation of blood clots
• Anesthetic complications
• Accidental injury to the neighboring tissues

What Post-Operative Care is needed at the Healthcare Facility after the Umbilical Hernia Repair surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Umbilical Hernia Repair surgical procedure:

What are the possible Risks and Complications after the Umbilical Hernia Repair surgical procedure?

Post Umbilical Hernia Repair procedure, the following complications may arise:

• Excessive bleeding
• Urinary retention
• Fluid accumulation around the surgical wound (Seroma)
• Loss of bowel/bladder function 
• Signs of an infection
• Recurrence of hernia

What is the Prognosis after the Surgery?

The prognosis for an Umbilical Hernia Repair procedure is usually excellent; a complete recovery without any complications is observed.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, and constipation
• Abnormal swelling
• Signs of an infection
• Fever
• Dizziness
• Feeling sick
• Muscle aches
• Headaches
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Umbilical Hernia Repair surgical procedure?

At home, the following post-operative care is recommended, after an Umbilical Hernia Repair procedure:

• Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
• Avoid all activities that are physically strenuous for about 6 weeks after surgery
• Resume driving as advised by your physician
• Use a heat pad or warm compress to relieve pain due to the incision
• Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with soap
• Resume showering; however, keep the wound clean and dry for the first 2-3 days after the surgical procedure, when you do not shower
• Replace the dressing on the surgical wound, as advised by your physician
• Complete the course of prescribed medication, as advised by your physician
• Take stool softeners to prevent constipation, under advice by the physician
• Take antibiotic medication to help combat or prevent infection, as directed by your physician
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, as necessary
• Immediately for a few weeks after the surgery, have a high-fiber diet. As you increase your fiber intake, also increase your fluid intake, in order to prevent constipation and stress during bowel movements and urination
• Avoid sex till complete healing has taken place (or follow physician’s advice)

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 3 to 6 weeks, to fully recover from this procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Umbilical Hernia Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or a hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• A general surgeon or a pediatric surgeon

The patient is advised to inquire and confirm the type of billing, before the Umbilical Hernia Repair is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA