Umbilical hernias include para-umbilical, supraumbilical and epigastric hernias. These are all classed as primary ventral hernias, meaning they occur naturally. Incisional hernias, by contrast, are secondary ventral hernias and develop at the site of a previous surgical incision.
Umbilical (navel) hernias usually occur in the middle of the belly button, causing a lump inside the navel to protrude. In some cases, the swelling appears just above the navel rather than directly within it.
Hernias can develop anywhere along the midline of the abdominal wall, from the navel up to the breastbone. When they occur higher up, they are known as epigastric hernias.
These hernias always form along the centre of the abdomen because they pass through the natural gap between the two rectus muscles. Although the lump may appear slightly to one side, the underlying weakness is always located in the midline.
What does an umbilical hernia look like?
It will appear as a bulge or lump inside the navel beneath the skin. It can vary in size, from the size of a small grape to a large grapefruit, it depends how big the hole in the abdominal wall becomes and how much pushes out.
KEY
1. Epigastric hernia
2. Diastasis**
3. Supraumbilical hernia
4. Umbilical hernia
If it’s a hernia, what exactly is the lump?
It is usually fat that lies beneath the muscle (part of our natural padding). Sometimes though, it may be intestine, and if that gets trapped then you have a problem. (See Strangulated Hernia)
Repair the umblicial hernia or ‘wait and see’?
You should repair it as soon as possible as whilst these hernias can be relatively painless, if left alone they always enlarge. Like all hernias, if left alone they:
a) run the risk of strangulating
b) are more difficult to repair
(See also Is ‘no treatment’ an Option?)
What is the best umbilical hernia repair method?
This depends on the size of the hernia defect. Those that are less than 1cm can be repaired without a mesh, using sutures which overlap the edges of the hernia defect (or hole or gap) as a double-breasted jacket. This makes a repair robust, with a negligible risk of recurrence or failure. Using mesh gives the best, most secure repair, for those that are over 1 cm.
Our experience proves that the mesh should be placed beneath the split or hole or defect and sandwiching it between the muscle layer and the lining of the tummy or peritoneum (sub-lay technique). Putting it on top of the muscle layer (on-lay technique), a commonly used approach, can lead to all sorts of problems such as fluid accumulation under the skin and infection. That is another practical reason why a mesh is also difficult to insert when the hernia defect is less than 1cm.
Open or keyhole repair for umbilical hernias?
Both work well. However, laparoscopic (keyhole) repair though, has three problems:
- Laparoscopic surgery cannot be performed under local anaesthesia. Patients need a general anaesthetic.
- You are making three or more holes to fix one. Only worthwhile if the hernia (and the defect) are fairly large, because the mesh that needs to be used to repair the hernia needs to be much larger than the size of the hernia defect. As a general rule, the mesh should be at least 3 times the size of the defect to get a good overlap around the defect.
- The mesh is usually inserted in between the muscle layers. But there are some surgeons who insert the mesh inside the abdomen. This can cause problems if the intestine sticks to it.
See also the section comparing Laparoscopic hernia repair and open mesh repair.
The British Hernia Centre
We are the UK’s only dedicated specialist hernia centre, with over 30 years of expertise. We have a proven track record and now perform more hernia operations, including umblical hernias, than any other surgical unit worldwide.
Contact our team today to find out more or to book a consultation.
