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Umbilical hernia repair in adults

Umbilical hernia is when the belly button pops outwards due to a weakness in the muscles in or around the belly button.

There is a separate factsheet available for parents of children having surgery to repair an umbilical hernia - Umbilical hernia in children

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

  • About umbilical hernia
  • Diagnosis
  • Preparing for your operation
  • About the operation
  • What to expect afterwards
  • Recovering from an umbilical hernia repair
  • What are the risks?
  • Sources
  • Related topics

About umbilical hernia

An umbilical hernia is a result of weakness in the muscles in or around your belly button. It causes the belly button to pop outwards and can happen at any age. Umbilical hernias are most common in women during and after pregnancy, and in people who are overweight.

An umbilical hernia is not dangerous in itself, but there is a risk that it will get trapped (incarcerated). This can cut off the blood supply to the contents of the hernia, causing life-threatening conditions such as gangrene or peritonitis (if this happens, the hernia is said to be strangulated). If it's not treated, your hernia is likely to get larger and become more uncomfortable. In most cases, a hernia repair operation is recommended.

Diagnosis

Your doctor will examine your belly button. The belly button will usually bulge out if you have an umbilical hernia.

An umbilical hernia can cause serious illness if it's left untreated in adults. The risk of illness increases with the size of the hernia. Your GP or surgeon will usually recommend umbilical hernia repair.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound or chest infection and slows your recovery.

Umbilical hernia repair is usually done as a day-case procedure under general anaesthesia. This means you will be asleep during the procedure. Alternatively you may prefer to have the surgery under local anaesthesia. This completely blocks feeling around the belly button area and you will stay awake during the operation. A sedative may be given with a local anaesthetic to help you relax.

Your surgeon will advise which type of anaesthesia is most suitable for you.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings.

About the operation

The aim of a hernia repair operation is to push the contents of the bulge back into the abdomen and strengthen the abdominal wall. There are two main types of hernia repair operations - open and keyhole. In most cases, the operation is an open repair, which involves a small cut just below your belly button. Sometimes, if the hernia is a recurrence, keyhole surgery is recommended.

Open surgery

A single cut (5 to 10cm long) is made just below or above your belly button, and the bulge is pushed back into place. Your surgeon may stitch a synthetic mesh over the weak spot to strengthen the wall of the abdomen. The skin cut is closed with stitches and covered with a dressing.

Keyhole surgery

Two or three small cuts (1 to 2cm long) are made in your lower abdomen. Your surgeon will insert a tube-like telescopic camera to view the hernia by looking at pictures it sends to a monitor. The hernia is repaired using specially designed surgical instruments passed through the other cuts. A synthetic mesh may be used to strengthen the wall of the abdomen. The skin cuts are closed with stitches.

The operation takes 30 to 45 minutes depending on the method used.

What to expect afterwards

If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually be able to go home when you feel ready.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wound before you go home. Your surgeon may prescribe antibiotics for a few days, although this is very rare. If you are prescribed antibiotics it's important you finish the course.

You may be given a date for a follow-up appointment.

Recovering from an umbilical hernia repair

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information that comes with the medicine and ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.

You will feel some discomfort in the abdomen area for a week or two. Don't strain or stretch the healing wound as this will increase swelling and slow your recovery. Don't do any lifting or strenuous exercise for at least the first two weeks. However, light exercise, such as walking, will help to speed up your recovery.

Don't have a shower or bath for the first two days. When you do bathe, the dressing may come off. This is normal and it does not need to be replaced.

Dissolvable stitches will disappear on their own in seven to 10 days.

What are the risks?

Umbilical hernia repair is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.

You will have some pain, bruising and minor swelling in your lower abdomen. The side-effects are usually milder after key-hole surgery.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Complications may require further treatment such as returning to theatre to stop bleeding, or antibiotics to treat an infection.

Other complications specific to umbilical hernia repair are uncommon but include:

  • damage to other organs in the abdomen - this is more likely if the operation is done using keyhole surgery and further surgery may be needed to repair any damage
  • pain or numbness in the lower abdomen - this may last several months
  • re-occurrence - it's possible the umbilical hernia may re-occur

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Sources

  • McLatchie GR, Leaper DJ. Oxford handbook of clinical surgery. Oxford University Press 2002:388
  • Menon VS, Brown TH. Umbilical hernia in adults: day case local anaesthetic repair. J Postgrad Med 2003;49(2):132-133
  • Should umbilical hernias be repaired to prevent complications if they are not giving rise to any symptoms? www.clinicalanswers.nhs.uk, accessed 13 February 2008
  • Oxford Textbook of Surgery: Volume 1. Morris PJ, Malt RA (eds). Oxford Medical Publications 1994:1409

Related topics

Caring for surgical wounds

General anaesthesia

Local anaesthesia