Umbilical Hernia Repair

In adults, factors that can contribute to developing an umbilical hernia include:

• Being overweight or obese.
• Straining while you are lifting or moving heavy objects.
• Having a persistent heavy cough.
• Having a multiple pregnancy such as twins or triplets.

Complications can develop as a result of an umbilical hernia including:

• Obstruction – where a section of the bowel becomes stuck outside the abdomen, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin.
• Strangulation – where a section of bowel becomes trapped, and its blood supply is cut off. This requires emergency surgery within hours to release the trapped tissues and restore the blood supply before the tissue dies.

If necessary, umbilical hernias can be treated with surgery to push the bulge back into place and strengthen the weakness in the abdominal wall. Surgery is recommended for most adults because the hernia is unlikely to get better by itself when you are older, and the risk of complication is higher.

Complications are uncommon, but can include:

• Infection of the wound (it may appear red, have a yellow discharge and be painful or swollen).
• Bleeding.
• Rupture of the wound (it opens up).
• The hernia returning.

The hospital will send you instructions about when to stop eating and drinking before the operation.

An umbilical hernia repair is a relatively simple procedure that normally takes about 20 to 30 minutes.

General anaesthetic is used so you will be asleep while the operation is carried out.

On occasion, local anaesthetic is used instead, but only for adults with a small hernia who are not in good enough health to have a general anaesthetic.

Your consultant will make a small cut of about 2 to 3cm at the base of the belly button and push the fatty lump or loop of the bowel back into the tummy. The muscle layers at the weak spot in the abdominal wall where the hernia came through are stitched together to strengthen them or a special mesh patch may be placed in the abdominal wall to strengthen the area instead.

When the repair is complete, your skin will be sealed with stitches. These usually dissolve on their own, within a few days of the operation. These are covered with a waterproof dressing on the day of surgery that should remain in place for five days. A spare dressing is usually given to you on discharge.

Local anaesthetic, which numbs the area, will be injected before the end of the operation to reduce the level of post-operative pain.

Before being discharged from hospital, you will be told whether you need to have a follow-up appointment. If an appointment is needed, you will be sent a letter in the post.

You will be able to go home the same day and must arrange for someone to drive you.

For the first 24 hours:

• Someone should stay with you until the general anaesthetic has worn off.
• Do not drive, operate machinery, or do any potentially dangerous activities (like cooking) until you have fully recovered feeling, movement and co-ordination.
• Do not sign any legal documents or drink alcohol.
• Get plenty of rest but stay active to avoid blood clots.

Make sure you follow the instructions you were given before leaving hospital about hygiene, caring for the wound and bathing.

A moderate amount of pain is normal so continue taking painkillers as advised by the hospital until your pain has settled. This is usually two to three days but can be longer.

You may have bruising and tenderness around the wound. This is normal and usually settles within about a week. However, the swelling may not go down for several weeks.

Applying gentle pressure to your wound, using your hand or a small pillow, can make coughing, sneezing and moving between sitting and standing more comfortable.

Wearing loose clothing may help reduce any discomfort, but you should be able to wear trousers or a skirt as normal.

Straining pn the toilet because of constipation can cause pain around the wound. Drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods such as brown rice, wholemeal bread and pasta can help reduce the chances of this occurring.

Most people make a good recovery and return to their usual activities within two weeks. Here are a few things you can do to make sure you recover well:

• Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about four to six weeks.
• You should be able to return to work after one or two weeks if your employment involves light work, or a bit longer if more manual. The consultant will be able to give you a “Statement for fitness” to work before discharge, if this is the case.
• You may find sex painful or uncomfortable at first, but it is usually fine to have sex when you feel able.
• Avoid driving until you are able to perform an emergency stop without feeling any pain or discomfort (you can practise this without starting your car). It will usually be one or two weeks before you reach this point after having keyhole surgery, although it may take longer after open surgery. We recommend you contact your car insurance company before you start driving again.

Contact your consultant, GP or dial 111 if you get any of the following symptoms:

• A persistent, high temperature.
• Bleeding.
• Increased swelling or pain in your abdomen.
• Pain that is not relieved by painkillers.
• Persistent nausea or vomiting.
• Chills.
• Persistent coughing or shortness of breath.
• Increasing redness surrounding your incisions.
• Difficulty passing urine.