What does the surgery involve?
Umbilical hernias can be repaired laparoscopically, open or a combination of both (hybrid). The most common technique is open repair with or without a sub-lay mesh.
An incision is made around the umbilicus the size of which depends on the size of the hernia.
The hernial sac is dissected out and usually pushed back into the abdomen. Sometimes the sac and its fatty contents may be excised.
The defect is assessed. If it is <1cm, it is usually closed with permanent sutures without the use of a mesh.
If the defect is >1cm, or the tissues are felt to be weak, a mesh is used. This is especially important if your work or lifestyle involves heaving lifting and straining.
A mesh is a piece of synthetic (or less commonly biological) material which is used to support the weak tissues around a hernia.
If a large mesh is required and has to be placed inside the peritoneal layer of the abdomen, laparoscopic fixation of the mesh may be required. This is where a scope is placed inside the abdomen via a different incision (usually on the left side). One or more laparoscopic ports are inserted through 5mm incisions to introduce a fixation device which is used to fix the mesh in position. When both open and laparoscopic techniques are used, the procedure is called a hybrid repair. It utilizes the best of both techniques.
The hernial defect is usually closed (under minimal tension) and mesh is place either underneath (sublay) or on top (on-lay) of the closed defect. If the defect cannot be closed, the mesh may be used to bridge the gap (in-lay). The best type of repair is one where the mesh is in the sub-lay position.
Pure laparoscopic repair of an umbilical hernia is done through three incisions on the left side of the abdomen.
The hernia is pulled into the abdomen away from the defect.
The defect is usually not closed.
A mesh is used on the inside of the defect and is fixed with tacks (small screws). These screws may be associated with a small risk of chronic post-operative pain. They are therefore avoided if possible by repairing most umbilical hernias using the open approach.
What are the risks of surgery?
Surgical procedural risks can be divided into anaesthetic and surgical risks.
Anaesthetic risks are usually discussed with the patient by the anaesthetic team.
Surgical risks specific to umbilical hernia repair include:
Infection – of the wound, the mesh or inside the abdomen.
Bleeding – inside the abdomen or within the wound (hematoma).
The risk of recurrence depends on patient factors and surgical factors. It increases with increased patient weight, size of hernial defect, smoking, increased intra-abdominal pressure by straining, lifting or coughing. Surgical factors include the position and size of the mesh, type of suture material used, post-operative complications such as bleeding or infection.
Other risks of surgery include:
- Deep venous thrombosis or DVT: formation of blood clots in the legs. This risk is reduced by wearing compression stockings (called TEDS), injection of blood thinning medications (Clexane) and mechanical calf-compression.
- Chest infection: This is prevented by adequate pain-relief, deep breathing and early mobilization. This is unlikely following umbilical hernia surgery.
Take regular Panadol (as long as there are no medical reasons for you not to take it such as an allergic reaction or liver disease).
Non-steroidal anti-inflammatory medication such as Neurofen and Voltaren can also help with pain and inflammation but should be taken on a full stomach. Take these for the first 3-5 days as required.
Stronger pain killers such as opioid anaelgesics (Endone, Codeine) should be taken sparingly as they can cause constipation which results in more straining.
You can have a normal diet once you are awake from the anaesthetic.
You will be able to walk normally despite some discomfort.
You should avoid any heavy lifting or straining for at least 6 weeks after surgery to avoid hernia recurrence.
Dressings are usually in two layers – Steristrips with a padded-Opsite on top.
These are waterproof so you can shower but cannot swim or have a bath for 2 weeks or until after your follow up wound review.
The top dressing stays on for 5-7 days.
Once the top dressing comes off, leave the Steristrips on for a few more days until they start to peel off by themselves.
You can usually go home on the same day.
A wound review by your surgeon or local doctor is advisable 1-2 weeks after surgery.
The appointment is usually made for you before leaving the hospital.