Hernia, Umbilical Repair



A hernia is an internal body part, like an organ which extends its way through a weak muscle or the tissue wall surrounding it. Normally, muscles are tough and resilient and keep the organs in their positions, however, when these muscles become fragile and weak, they lead to hernia formations.
An umbilical hernia is a condition commonly found in young children, with one-sixth of the children getting impacted by it. In this type of hernia, a piece of tissue or fat or bowel, thrusts through the abdominal region close to the umbilicus or belly button.
Causes of umbilical hernia
During childbirth the umbilicus of the baby is sealed and closed after detaching from the mother’s umbilical cord. In some cases, the baby’s abdominal muscles are not able to seal fully, hence making a weak muscle area around the belly button. This causes umbilical hernia to form.
In majority cases, almost 90%, by the time the child turns one year, the hernia retracts and the muscles around it become stronger and reseal the area. The doctor would wait for the child to be a year to see the whether the hernia retracts itself or not. If it does, no medical intervention or surgery is required.
In rare cases, a piece of bowel or tissue slips into the hernia to form a bulge which can be seen and felt over the belly button or umbilicus. This can be painful can cause vomiting and damage to the baby’s intestines. This can be prevented through a small surgery, which puts the hernia back in its place and strengthens the walls of the abdomen in that area. This is referred to as Umbilical hernia repair.
In certain cases, adults can also develop umbilical hernia, risk factors being multiple pregnancies, heavy weight lifting, being overweight or obese and constant coughing.
Surgery – preparation and procedure
For preparing for the surgery, the child needs to be empty stomach four to six hours prior. Water can be taken for up to two hours prior to the surgery. A general anaesthesia is administered into the child so he goes to sleep. The whole operation procedure takes 20 – 30 minutes, after which is child is transferred to the recovery room.

Surgery procedure involves the following steps:

  • A small incision of 2-3 cm is made at the base of the umbilicus, to push the bowel or fat piece back into its place behind the wall of abdomen.
  • The muscle layers are stitched to repair the weakness in the muscles of the area. If the defect or weakness in the area is extensive, a mesh patch is used for strengthening the region.
  • The incision is sealed with special glue or dissolvable stitches.
  • The child does not feel any pain during the procedure, however, post operation, for few days the child may feel uncomfortable and sore. Painkillers are advised to deal with the same.
  • The child is allowed to go home in a few hours after the surgery. They should soon be made to eat or drink and also go to the toilet.
  • However, in case the child has any other medical problems or vomit consistently without being able to take in food or water, they might be asked to stay overnight in the hospital. There are no long-term effects of this surgery, it is completely safe.

Complications and risks

Although complications with the surgery are rare, there could be certain possible risk factors, as outlined below:
Infection in the wound post operation. This can be treated with antibiotics.
Bowel getting strangulated inside the hernia. This would need carrying out a bowel resection.
Hernia reappearing in very few cases.

Recovery

The child may feel sleepy and watery-eyed after surgery and would expect more attention. Soreness and sensitivity around the wound will last for a week. The wound should be kept dry. Showering is fine, however, swimming and bathing should be avoided for 5-7 days. Painkillers like paracetamol or ibuprofen can help in pain relief. The child stays lethargic till the feel comfortable and normal to get back to their routine activities. School going children can get back to school in a week’s time. Sports and outdoor games should be avoided for 2 weeks after joining school.
The belly button becomes inverted and normal after the operation. If the hernia had been large and there is some excess skin is seen after the surgery, it disappears with time.

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