What is an umbilical hernia?
Umbilical hernias are defects in the closure of the umbilical ring that should have occurred before 5 years. After this time, if it has not closed, the patient will have a persistent hernia.
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These are some of the FAQs about umbilical hernia surgery.
Umbilical hernias are primarily detected by the patient when he/she feels a lump in the navel that may or may not hurt. A visit to a physician will confirm the finding.
In particular, in cases where the patient is obese, and the adipose panniculus does not explore the umbilicus, an ultrasonographic study will be requested. This will show the size of the hernial opening, the dimension of the sac, and the type of content, which can be a fat or intestinal loop.
The defect will dilate when there is an increase in intra-abdominal pressure as in obesity, pregnancy, chronic coughers such as asthmatics or chronic bronchitis, people who carry weight daily, either by exercise or work, heavy smokers, intra-abdominal alterations resulting in the accumulation of fluids, among others.
The possible complications of enlarged umbilical hernias that are not operated on are that a segment of intra-abdominal fat or intestine may protrude and get stuck in the ring, which will cause severe pain resulting in a surgical emergency.Some patients already live with hernias that have trapped fat segments and let time pass until the emergency arises. It is not recommended to do so; immediately an umbilical hernia is detected, a surgeon should evaluate it, and it should be determined if it requires repair.
Most patients report symptomatology. Among them, pain at the hernia site; is non-specific, mild to moderate, constant, it calms down when the patient lies down. If the hernia is complicated by entrapment or incarceration, the pain becomes more intense, persistent and does not go away with position changes.
Nausea and vomiting may occur. If the incarceration squeezes the contents, color changes are easily visible on the skin: red, purplish, black. The trapped content, as mentioned above, can be the intestine, which can lead to a catastrophe with ischemia of its wall and perforation. The patient enters a critical state with increased respiration, sweating, increased heart rate, and intense pain in the abdomen’s central part.
The treatment is imperative with surgery; the hernia must be closed, the procedure is called umbilical plasty. It can be open or laparoscopic. Open surgery consists of making a small semilunar incision inside the umbilical scar, reaching the site of the hole, and closing it with special sutures.
The placement of mesh or prosthetic material is preferred when the defect is more significant than 2 cm. It can also be operated by laparoscopic surgery. Still, it is also recommended in larger hernias because the surgery itself involves making 3 incisions of 1 cm and general anesthesia, increasing the cost of the procedure.
The umbilical hernia surgery is ambulatory, the operation is performed, and the patient can go home to rest.
If the patient is over 50 years old, is diabetic or hypertensive, or has a chronic lung disease, he/she must undergo a preoperative assessment with an internist who will identify risks through questioning and physical examination of the patient complemented with laboratory studies, chest x-ray and electrocardiogram.
On the day of surgery, the patient must fast for 6 to 8 hours, be bathed, and be accompanied by an adult.
Care after hernia surgery consists of washing the wound with soap and water every day, drying it, and covering it with sterile gauze. The stitches will be removed 7 days after the day of surgery. Exercises involving increased abdominal pressure should not be performed for at least 2 months.
Complications of umbilical plasty are similar to any other surgery. They are infrequent. Seromas may appear, consisting of accumulating serum or transudate fluid from the fatty tissue cells located under the skin. The treatment consists of drainage through the stitches compressing the wound with gauze; sometimes, it can be drained with punctures and a syringe. As a last alternative, one or two stitches will be removed to improve fluid drainage.
There may also be hematomas which are blood accumulations by a small blood vessel that begins to leak. Treatment also consists of drainage and compression of the skin with gauze.
Another complication that may appear is skin and fatty tissue infection, developing abscesses, and cellulitis. The skin will be reddened, hot to the touch, and purulent material may come out through the stitches. It is accompanied by local pain. Treatment will also require the removal of stitches to expose it and wash it with antiseptic solutions. Samples are taken for culture, and antibiotics are started. It can be closed again in 5 to 7 days or left to close spontaneously.One of the rare complications that may occur is that the skin may become necrotic, requiring removal under local anesthesia, leaving healthy tissue and closing it with sutures, or being left to spontaneous closure with daily healing.