Symptoms

The symptoms in patients suffering from umbilical hernia can be quite different. In this context, the severity of the umbilical hernia plays a decisive role. In most cases, an umbilical hernia does not cause problems in children or adults.

Nevertheless, symptoms of varying severity can occur. One of the most common symptoms of an umbilical hernia is the occurrence of abdominal pain (abdominal pain). These abdominal pains appear in varying intensity depending on the extent of the disease.

However, the localization of the symptoms is in most cases limited directly to the umbilical region. In addition to the typical abdominal pain, a tumor in the region of the navel with varying degrees of severity is one of the most striking symptoms of an umbilical hernia. In many cases, however, this tumor is so insignificant that it is not noticed by the affected patients over a long period of time.

In these patients, a significant protrusion of the intestinal loops and an associated enlargement of the tumor only occurs under the influence of high pressure on the abdomen (e.g. when coughing, lifting). Classical situations in which the umbilical hernia can be recognized as such in these patients are during coughing and bowel movements. In addition, a visible tumor may be present as a permanent symptom or recede while lying down.In such cases it is a reponsible umbilical hernia, which can often be treated without surgery.

In contrast, the so-called “irreponible” umbilical hernia does not regress while lying down and usually has to be treated surgically in a timely manner. Both the occurrence of pain and the development of a visible protrusion of the navel are classic symptoms of umbilical hernia, but this clinical picture can also occur completely without subjective symptoms. In such cases, the affected patients only report a pulling in the umbilical region, which increases in intensity during physical exertion and almost completely disappears when at rest.

If the formation of the umbilical hernia causes the incarceration of individual sections of the intestine, the symptoms perceived by the patient change within a very short time. The clamping off of the intestinal loops leads to a decrease in blood flow which ultimately leads to the tissue dying off. Clinically, this means that the patient has the image of a so-called “acute abdomen“.

Classical symptoms of the acute abdomen are sudden, severe abdominal pains which have a different localization depending on the cause. Depending on the extent of the underlying disease, the abdominal pain may be limited to one region or radiate widely. In addition, the abdominal cavity is usually “hard as a board” in the presence of such a pronounced umbilical hernia with clamped intestinal loops.

The affected patients may also develop pronounced general symptoms such as fever, chills, nausea and/or vomiting. If the affected patients do not promptly undergo appropriate surgical treatment to reposition the affected bowel segments, a life-threatening state of shock may result. If pain in the area of the umbilical hernia occurs following surgical correction, this is usually interpreted as harmless.

In the first days after the surgical procedure, light painkillers such as ibuprofen or paracetamol can be taken. In case of severe pain, the attending physician can prescribe stronger painkillers (e.g. Novalgin) if the patient wishes. Many patients still complain of occasional pain weeks after the umbilical hernia operation.

Especially when lifting heavy objects, coughing or doing sports, the pressure in the abdomen increases. In this way, the tissue already irritated by the operation is strained and pain is triggered. The affected patients should regard these pain phenomena as an indication that too much strain has been put on them.

An umbilical hernia requires a long recovery time even after the surgical repositioning. Especially lifting heavy loads and excessive physical activity should be avoided within this period. As a rule, the body clearly indicates which type of load is too much and at which point the full load capacity is restored.

There are basically two different methods of umbilical hernia surgery: an open procedure or a laparoscopic procedure. A laparoscopy is a laparoscopy with special tubular instruments called endoscopes. With the help of these instruments one is then able to look into the abdominal cavity.

When to use which method depends on the type of umbilical hernia. In principle, it is a bow-shaped incision, which is made by the surgeon. The hernia sac is then moved back into the abdominal cavity.

The further procedure depends on the size of the hernia sac. For umbilical hernias with a diameter of 2 cm and patients without risk factors for a new umbilical hernia, the open procedure with direct suture closure of the hernia hole is usually chosen. The direct procedure can be performed on an outpatient basis.

If it is an umbilical hernia with a larger hernia hole, a different technique is usually chosen, since the probability of a repeated umbilical hernia is then up to 50%. In this case, a method with a plastic mesh made of polypropylene is chosen. The mesh is inserted using a specific technique called the sublay technique.

The net is placed between the abdominal wall and the peritoneum. It is also important to ensure an overlap of at least 5 cm of the hernial orifice to prevent a repeated hernia. The net is then cut as small as possible.In principle, the operation must be performed under general anesthesia and as an inpatient.

After about four days the patient can be discharged from the inpatient treatment. After the operation it should be noted that moderate exercise such as walking can be resumed at the beginning. Heavy physical work, on the other hand, should only be resumed after three to four weeks.

In laparoscopy, instruments are inserted into the abdomen through small openings in the tissue. The laparoscopic procedure is preferred for larger umbilical hernias. In a first step, adhesions of the abdominal wall are first removed.

Special care must be taken to avoid damaging the surrounding intestine. Here too, a net is inserted which is fastened with sutures and staplers. The net has a special coating.

So that no repeated umbilical hernia takes place, one must pay attention also here to an overlap of 5 cm of the edges. During the operation a general anesthesia with in-patient treatment is required. For post-operative treatment, an abdominal bandage should be worn and a constant dietary increase should take place.

The abdominal bandage prevents further complications such as wound water accumulation and bruising. As a rule, the end of inpatient treatment is five days after the operation. Here, too, slight mobilization can take place immediately and after three to four weeks, physically heavy work can take place again.

Surgical complications: A possible complication caused by the plastic mesh is the formation of wound water accumulations and bruises. In addition, an inflammation of the surgical wound can occur. The most feared complication is a renewed umbilical hernia, which should be prevented by overlapping the plastic mesh. In principle, however, the occurrence of renewed umbilical hernias has been significantly reduced by the use of meshes as opposed to direct sutures.

Open procedures:
Laparoscopic procedures: