Umbilical Hernia
An umbilical hernia is a bulge at the umbilicus, known as the belly button. This occurs because that area of the abdominal wall must remain open to allow the blood vessels of the umbilical cord to pass in and out of the abdominal cavity. When the baby is born, a process begins that usually stimulates that hole to contract to a point that ultimately results in its disappearance. Failure of this process to complete results in a persistent hole in the abdominal wall through which abdominal contents can protrude and create a very unsightly bulge.
Six out of ten umbilical hernias with a diameter of less than 1 cm (approximately the width of a normal adult's index finger) will close within the first two years of the baby's life. The most worrisome complication is when a piece of intestine gets trapped and cut off from its blood supply (a strangulated, incarcerated hernia). This is a rare occurrence. The usual presenting symptom is a relatively large bulge in the umbilical area that comes and goes.
What can I expect regarding care?
When pediatricians identify babies with umbilical hernias, they usually recommend operative repair only if the lesion persists after the baby has reached 2½-3 years of age. There are two reasons for this. First, the likelihood of ongoing contraction with gradual decrease in the size of the defect continues for the first two years of life. Second, the area around the defect is a very active metabolic area and is not as strong as the more mature fascia of the abdominal wall of an older child or adult. Placement of the sutures necessary to close that fascial defect may result in the sutures lacerating the fascia, causing a recurrence of the hernia that would be even more complex than the original problem. Thus, the majority of pediatric surgeons routinely consider surgical repair on children who have reached at least 2½ years of age and have no other significant problems.
Like an inguinal hernia, once this is identified, it usually results in referral to a pediatric surgeon, who, after examination and review of the child's medical history, will discuss much of what has been described above, as well as the procedure.
How is it corrected surgically?
The basic defect of an umbilical hernia is the persistent gap in the abdominal wall under the skin in the area of the umbilicus. Repair is accomplished through an incision in the skin overlying the umbilicus and placement of strong, non-absorbable sutures to close the fascia. The overlying skin is then loosely tacked to the fascia so that the umbilicus becomes an "inny" as the process of healing continues. The actual skin incision is closed with an absorbable suture. The area should be kept clean and dry for two to three days, after which the suture will dissolve automatically.
One question that frequently arises relates to the extra tissue that is produced as a result of the large bulge through the fascial defect. The greater majority of pediatric surgeons strongly recommend that this tissue be left alone rather than removing it surgically in an attempt to create a new umbilicus. The new umbilicus is never as normal looking as the native umbilicus. Moreover, the extra tissue gradually remodels and forms a normal appearance as the child continues to grow and develop. Thus, the actual repair of the umbilical hernia may have very little outside change other than the absence of the bulge and the persistence of extra skin that will gradually resolve.
The operation usually takes less than one hour in an outpatient procedure and, as with all procedures done by the University of Florida Division of Pediatric Surgery, involves the careful use of anesthetics so that the child's postoperative care is pain free. Currently, 96 percent of our patients experience no pain after their operation.
What kind of complications should I expect?
The most significant complication, as with any operative procedure, is infection. The other problem relates to the issue of recurrence, which can occur if the sutures (stitches) used to close up the hole in the tissue (fascia) come loose or if the tissue becomes weakened during the healing process.
What kind of follow-up care is required?
Care for these children is very similar to those who undergo inguinal hernia repair and usually require one to two follow-up visits to confirm complete healing of the incision. The repair should last for a lifetime and have no further problems.
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