Umbilical hernia
Treatment
The aim of treatment is to eliminate the umbilical hernia through a successful, gentle operation that avoids complications. The type of operation (surgical technique) is determined by the size of the hernia, the location, the type of hernia (primary umbilical hernia or recurrent hernia), the patient's health and age, as well as the expertise of the surgeon. In laparoscopic surgery, a large, overlapping mesh implantation with general anesthesia, intubation and the administration of muscle relaxants to switch off the muscles for the duration of the operation is the rule. Depending on the size of the defect, an open operation allows for an operation using a suture technique without a mesh under local anesthesia. The risks of surgical techniques for wound infection, immediate postoperative pain, seroma and hematoma are comparable, according to the American College of Surgeons. Laparoscopic procedures have higher rates of complications (e.g. readmission to the operating room for revision), pneumonia, urinary tract infection. The recurrence rate after suture procedures is higher than after mesh procedures.
Symptoms
The umbilical hernia often does not cause any discomfort (symptoms); There is only a bulge in the navel, which bulges outward when coughing and/or greater pressure in the abdominal cavity. The dangers of an umbilical hernia without symptoms are often underestimated if you wait for pain in the navel to occur. The umbilical hernia is said to be reducible if it can be pushed back without pain. If the hernia sac with intestine or fatty tissue can no longer be reduced, the umbilical hernia is described as non-reducible (hernia accreta) or incarcerated. The umbilical hernia is described as a strangulated hernia when the intestine is pinched and the blood supply is cut off. The hernial sac is usually palpable as hard and nodular with severe pain, possibly accompanied by vomiting. This is an absolute emergency and requires immediate surgery. Emergency surgeries are more prone to complications. In addition to a careful clinical examination of the navel and abdominal cavity, an ultrasound examination, if necessary CT and MRI, blood test, urinalysis and ECG should be carried out.
Causes
The umbilical hernia (umbilical hernia) forms due to weak connective tissue and pressure in the abdominal cavity in the navel and the area surrounding the navel due to the protrusion of fatty tissue and/or intestine. About 10% of abdominal wall hernias are umbilical hernias. These changes are more common in people over the age of sixty as the muscles become weaker. Most adult umbilical hernias are acquired due to increased pressure on the navel from within.
Risk factors for umbilical hernia are older age with muscle weakness, overweight and obesity with increased pressure in the abdominal cavity, chronic straining, family history, ascites with increased pressure in the abdominal cavity due to fluid, pregnancy, especially multiple pregnancies.