Umbilical/ventral/ incisional hernias
An umbilical hernia occurs when the abdominal cavity lining containing the intestines pushes through a weakness in the abdominal wall at the belly button. Generally, they are harmless. About 10% of hernias are umbilical hernias.
Umbilical hernias are common in children. This type of hernia may occur at birth when the hernia pushes out the belly button and is noticeable when a baby cries due to an increase in abdominal pressure.
In infants, the cause is due to the fact that in utero, the umbilical cord passes through a small opening in the baby’s abdominal muscles. It is supposed to close just after birth. However when the muscles don’t close completely, the hernia may appear at birth or later in life.
Infants with umbilical hernias usually do not require treatment because the majority of the time, the hernia shrinks and closes by itself, by the time the child is 1-2 years old, although sometimes it can take longer to heal itself. When the hernia fails to disappear by age 4, to prevent complications, may require repair.
Symptoms include: a soft swelling or bulge. When the baby seems to be in pain, vomits and the bulge becomes tender, swollen or changes color, emergency care is required. However, complications are generally rare.
Signs that surgery is necessary include:
- The hernia is painful, and stuck in the bulging position
- Blood supply to the intestine is being affected as indicated by a change in the color of the bulge.
- The hernia fails to close on its own, and/or
- The defect is large, or parents find it unacceptable.
In most cases, repair will be delayed until the child reaches 1-2 years of age, to determine whether it will close on its own.
Adults often experience abdominal hernias as well. They are especially evident in obese people and in women after pregnancy. They do not heal themselves, and tend to enlarge over time.
Adult umbilical hernias are more likely to evolve into incarceration or strangulation. Symptoms include:
- The inability to push the hernia back into the body
- Pain and tissue damage
- Change in color
During pregnancy, abdominal pressure increases and the abdominal muscles are stretched apart by the pregnancy. Other potential causes include multiple pregnancies, and previous abdominal surgery.
When the hernia is small without symptoms, watchful waiting may be appropriate. The risk remains that the hernia will grow in size, and that the protruding fat and intestines may get stuck outside the body and become incarcerated, which is painful. If the blood supply is compromised (strangulation) it requires emergency surgery. Symptoms of this are nausea, vomiting and the bulge turns blue or a darker color.
Open surgery or laparoscopic surgery are the procedures available.
Because this is a significant risk, it is often recommended that the hernia be repaired surgically to prevent incarceration and strangulation. However, there are risks from surgery as well.
Risks are low, but the general risks of any surgery apply here- anesthesia risks, bleeding, blood clots, and infection. Specific risks from umbilical hernia repair may include injury to the intestines, and a small risk that the hernia will come back.
Ventral Hernias are often Incisional Hernias
Ventral hernias occur in the abdominal wall where a previous surgical incision has been made, because this muscles in this area have been weakened, weakened surgical wounds, infection, hematomas or seromas which decrease wound healing.
An abdominal wall incision creates a potential weakness and is at risk of developing a hernia. So activities like heavy lifting, aging, obesity, injury or infection after abdominal surgery can cause a hernia to develop. However, ventral or incisional hernias may not become apparent for years after the procedure, or occur immediately after surgery. Ventral hernias can also occur near the belly button or any other area of the abdomen.
As with all abdominal hernias, there will be a bulge, which can be painless or become painful with straining, lifting heavy objects, coughing or straining during bowel movements. It can also cause symptoms when the patient sits or stands for too long. The pain may be a dull ache that worsens by the end of the day, or a sharp pain. Occasionally, an abdominal wall binder may be prescribed, but typically is not not effective.
When the discomfort becomes severe, or is constant, there is redness, the color of the bulge changes to blue or purple, and there is nausea and vomiting, this indicates potential entrapment or strangulation, and should be reported to the physician.
Surgical repair can be via open surgery or laparoscopic surgery. Usually laparoscopic hernia repair is the first choice, because previous abdominal surgery complicates hernia repair. Open surgery with incisions in the scar area are at risk for infection, and large incisions are required and result in significant post-operative pain. Finally, hernias in this area have a high rate of recurrence when simple sutures are used due to tension on the incision. Thus, mesh is the preferred repair method because it is tension free.
The surgeon in his sound medical judgment may decide that to keep the patient safe, he may convert the surgery to an open procedure. The goal of surgery is relief of the patient’s symptoms and cure of the hernia with minimal risk of recurrence.
Anyone can develop a hernia at any age. Aging and certain activities can increase the risk of a hernia.
Each year in the U.S., some 350,000 to 500,000 ventral hernia repairs are performed.
The general surgeons at BASS Medical Group are board-certified and experienced in hernia diagnosis and repair, and they are Fellows of the American College of Surgeons. Our multi-specialty group is dedicated to your health and well being. Choosing the right surgeon to perform your surgery is one of the most important decisions a patient can make. Our offices are conveniently located in San Francisco, and the East Bay, California, to serve our patients. Find the location convenient to you. Then call BASS Medical Group to schedule a consultation to discuss your concerns, get answers to your questions and receive professional, quality care.