Umbilical hernioplasty surgery: step-by-step

• An umbilical hernia occurs when there is a bulge or protrusion of an organ (usually the small intestine) due to a defect in the abdominal wall.
• The definitive option for repairing an umbilical hernia is surgery (hernioplasty), which can be open surgery or laparoscopic.
• Hernioplasty involves placing a prosthetic mesh in the weakened area of the abdomen to strengthen the abdominal wall and prevent the hernia from recurring.

Hernias are formed as a result of a defect in the abdominal wall, which can occur due to different causes that we will explain throughout the text.

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The abdominal wall is the muscle under the skin of the front part of the trunk whose weakening can lead to a tear through which part of the peritoneum that lines the inside of the pelvic-abdominal cavity slips, forming what is known as a hernia or hernial bulge.

An umbilical hernia, as its name suggests, is one in which a hernial protrusion ("bulge") appears in the area of the navel or around it. Below are some of the causes of umbilical hernias:

Generally, umbilical hernias are due to a congenital defect, i.e. during the mother's gestation period it is possible that the abdominal wall of the foetus does not close properly and that, in the long run, the hernial defect occurs.

Despite the existence of this defect in the closure of the abdominal wall of the foetus, it is possible that a hernia never forms, although when it does appear, the most frequent causes are the following:

Significant physical exertion such as heavy lifting.

• Persistent coughing
• Constipation
• Increased pressure in the abdominal area during pregnancy, for obvious reasons.
• Obesity, due to increased abdominal wall pressure.
• Previous surgeries

Umbilical hernias can lead to a number of complications, for which surgery (hernioplasty) should be indicated without much delay or even referred to emergency surgery in some cases.

These complications are incarceration of the hernia, which means that the hernial defect is irreducible manually, as well as strangulation of the hernia, which coincides with the previous one in that the umbilical hernia is irreducible but also compresses the herniated tissue causing a reduction in the blood flow of the tissue, the intestine in most cases, requiring emergency hernioplasty surgery to avoid tissue necrosis.

This is why it is recommended to operate on hernias as soon as possible to avoid this type of complication, with hernioplasty surgery being the most commonly used option today.

As mentioned above, a strangulation of the hernia is sufficient reason to operate on the hernia, otherwise it can lead to serious problems for the patient.

Small umbilical hernias are usually asymptomatic and do not require surgery as a rule. However, those patients who present symptoms or a bulky hernia are candidates for surgery (hernioplasty) to avoid possible complications in the future umbilical hernia repair operation: hernioplasty.

Umbilical hernias can generally be repaired by herniorrhaphy or hernioplasty, the latter being the most commonly used nowadays, as we have already mentioned. This technique is not only indicated for repairing umbilical hernias, but for any type of hernia located in the abdominal wall.

Hernioplasty is a technique that consists of placing a synthetic mesh in the defective area of the abdominal wall, which makes it consolidate and considerably reduces the possibility of a new hernia appearing.

Hernioplasty can be performed using two types of approach:

• Open surgery: This is the conventional technique and allows the hernia to be resolved in a very comfortable way for the surgeon.
• Laparoscopic surgery: This uses a laparoscope and allows a much faster recovery for the patient, as well as practically eliminating scars.

As we mentioned, there are two ways to perform a hernioplasty, which we will now explain step by step.

Open surgery

1. The surgeon makes an incision just above or below the navel until the hernia defect is reached.
2. The specialist reintroduces the hernia defect to its original position inside the abdomen.
3. The area of weakened abdominal wall muscle is sutured.
4. A synthetic mesh is placed over the muscle in order to consolidate the abdominal wall and prevent it from reproducing.
5. Finally, the specialist sutures the incision layer by layer and then covers the wound with a bandage. After this, the patient is woken up and taken to the resuscitation room where he or she will recover completely.

Laparoscopic surgery

1. The surgeon makes two or three small incisions on one side of the abdomen.
2. Through one of the incisions, a laparoscope (a small instrument with a camera on the end that allows the surgeon to see inside the patient) is inserted. A gas will have been inserted through another of the incisions to enlarge the abdominal cavity and allow the surgeon to work more comfortably and safely for the patient.
3. The surgeon repairs the hernia with the appropriate surgical instruments inserted through the remaining incisions.
4. In this case, the surgical mesh is placed in the inner area, unlike in the case of open surgery.
5. Finally, the specialist closes the incision with stitches and covers the wound with a dressing.

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Both types of surgery are performed under general anaesthesia in most cases (depending on the size and severity of the hernia). It is a simple type of surgery, lasting around 30-40 minutes.

It is also an outpatient procedure, so the patient can leave the hospital on their own feet on the same day of the operation, although in many cases, especially if the surgery is performed in the afternoon, the patient spends a night in hospital.

Return to normal activities after umbilical hernioplasty surgery occurs four weeks after the surgery, although in many cases it may be earlier. This should be consulted with the surgeon who has operated on the patient, as it will depend on each specific case.

In conclusion, we can say that the most advisable thing to do when an umbilical hernia appears is to operate on it to prevent it from getting worse. Furthermore, by resolving the problem with umbilical hernioplasty surgery, the patient will feel great relief from the pain that the hernia may cause.

Do you need umbilical hernia surgery?

Request a free and immediate appointment with our specialists in General Surgery

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