Umbilical hernia repair

Umbilical hernia repair surgery

Umbilical hernia is the case, when a part of the abdomen or intestines sticks out through a weak point close to the belly button (umbilicus). Umbilical hernia repair surgery involves the procedure to be done to push the resultant protruding tissues and reinforce the abdominal wall.

It is a non-invasive and non-surgical operation, which is not only safe but also appropriate in adults and children.

Umbilical Hernia Repair Types

Repair of open Umbilical Hernia:

• A tiny piercing is done around the belly button.
• The protruding tissue is retracted inwards.
• The sutures are used to close the defect.
• Mesh can be applied in case the hernia is large (>2 cm) to decrease the recurrence.

Laparoscopic Umbilical Hernia:

• Carried out by means of very small keyhole openings with a camera.
• The abdomen is reinforced by placing mesh in the abdomen.

Advantages:

• Less pain
• Faster recovery
• Minimal scarring
• Lower infection risk

Umbilical hernia repair procedure

Umbilical hernia repair is a surgical intervention undertaken to fix the deficiency in the strength of the abdominal wall around the navel (umbilicus) whereby a bit of intestine or fatty tissue sticks out. The surgery is done to place the protruded tissues back to the abdomen and support the abdominal wall to avoid the recurrence.

Pre-operative Preparation

Clinical evaluation

• Physical examination to determine the size of a hernia.
• Symptoms (pain, swelling, discomfort) discussion.

Investigations

• Ultrasound or CT scan (in case of large and/or complicated hernia).
• Blood tests, ECG, chest X-ray (on fitness).

Anaesthesia planning

• Adults: typically general anaesthesia.
• Children / small hernias: local or regional anaesthesia can be utilized.

Fasting

• Neither food nor drink 6-8 hours before surgery.

Surgical (Open or Laparoscopic) Operation

Treatment of umbilical hernia involves either laparoscopic (keyhole) surgery or open surgery:

Open Umbilical Hernia Repair

Step-by-Step:

Incision

• A curved or a horizontal incision is done just beneath the belly button or around it.

Hernia Exposure

• The fat or intestine hernia sac is discovered with care.

Reduction

• The sticking out tissue is forced to the abdominal cavity.

Repair of the Hernia Defect

• Small defects (less than 2 cm): sutured very strongly.
• Big defects (>2 cm): fixed with a surgical mesh to avoid recurrence.

Closure

• Sutures or skin glue are used to close the incision.

Duration: 30–40 minutes

Setting: Day-care procedure

Umbilical Hernia Laparoscopy

Step-by-Step:

Small Incisions

• On the abdomen, 2-3 small cuts are created.

Placing of Camera and Instruments

• A laparoscope (camera) is placed.

• CO 2 gas is injected to inflate the abdomen and improve the visibility.

Hernia Reduction

• Laparoscopic instruments are used to push the hernia sac back in to position.

Mesh Placement

An artificial net is inserted in the abdomen, over the defect and secured by:

• Tacks
• Sutures
• Glue (in some cases)

Closure

• Small holes are patched by use of sutures or glue.

Duration: 45–60 minutes

Advantages: Reduced pain, reduced scars, reduced time to heal.

Post-operative Care (Right after Surgery)

Monitoring in recovery room

• Vital signs, pain scale, and location of wound are monitored.

Pain management

• Painkillers that are administered orally are normally adequate.

Discharge

• Majority of the patients come home either on the same day or the following day at the dawn.

Postoperative Umbilical Hernia

• Normal Activities
• Walking: same day
• Desk job: 5–7 days
• Strenuous work/gym: 4–6 weeks

Wound Care

• Keep area clean and dry
• Avoid lifting heavy objects

Follow-up

• Usually 1–2 weeks after surgery

Factors Affecting Umbilical hernia repair cost India

These are the main determinants that affect the cost of umbilical hernia repair in India:

Type of Surgery (Open vs Laparoscopic vs Robotic)

• An open repair is usually cheaper than laparoscopic one due to the simplicity of the instrumentation and less duration of the operation. 
• Laparoscopic (keyhole) repair requires special equipment and in most cases the use of mesh through minimal access- this increases the cost. 
• Simple umbilical hernia would be more expensive with the involvement of robotic-assisted surgery (RA). 

Size, Complexity and Recurrence of Hernia

• A simple hernia (small and simple) is less expensive to repair than a big defect, an incarceration/strangulation hernia or recurrent hernia. 
• In case the hernia is more dissectable, needs increased operating time, or more surgical procedures, the cost increases.

Use & Type of Mesh

• Mesh usage (quality/brand) may also impose significant cost. There are advanced/ imported mesh materials, which are more expensive. 

Facility / Hospital Level & Location

• Most hospitals in large cities (Delhi, Mumbai, Bengaluru etc) tend to be higher billed due to increased overheads. 
• The premium/ private multi-specialty hospitals (that have their own rooms) with luxury facilities, modern infrastructure will be more expensive than the small hospitals or government/ charity arrangements. 

Surgeon/ Anaesthesia/OT Costs

• Experience and specialization of the surgeon (e.g. laparoscopic hernia specialist) could lead to professional fees that are higher. 
• Cost depends on choice of anaesthesia (general vs local/regional), OT time and complexity of surgical team. 

Pre-operative Investigations and Health of the patient

• In case the patient has comorbidities (diabetes, hypertension, obesity), an increased number of tests, monitoring and risk management might be necessary → increased cost. 
• Further testing (ultrasound, CT, blood work) or length of stay adds up to total cost. 

Hospitalization and Postoperative management

• Hospital stay (day-care or one or more nights), room type (shared or private), nursing care, medications, etc. are all cost-adding factors. 
• The bill is also increased by complications that might need further attention, ICU, additional drugs or prolonged observation.

Best hospital for umbilical hernia repair India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Laparoscopic umbilical hernia repair

Laparoscopic umbilical hernia repair is a keyhole operation involving a minimally invasive laparoscopic procedure that is designed to fix a defect of the abdominal wall around the belly button. This procedure entails the use of cameras and instruments to insert through small holes and fix the hernia and strengthen the area with a mesh.

This is a quicker healing process, less painful and scarring is minimal in comparison to open surgery.

Indications of Laparoscopic Repair

The laparoscopic repair is desirable when:

• The hernia is moderate to huge.
• Recurrence of open repair made in the past.
• The patient is obese/overweight.
• Faster recovery is desired
• The abdominal wall defects are several.

Laparoscopic Procedure for Umbilical Hernia

Anaesthesia

• General anaesthetically done.
• The procedure is painless, the patient is completely asleep.

Creation of Small Incisions

• The abdomen is typically incised 2-3 times (0.5-1cm each time).
• These are located in locations outside the umbilicus.

Insufflation of CO₂ Gas

• Carbon dioxide gas is placed in the abdomen.
• Provides a place where the surgeon can see and work.

Introduction of Laparoscope and Instruments

• One of the ports is a laparoscope (camera).
• Dissection tools are long and thin, and thrown in other ports to place mesh.
• The surgeon looks at a monitor at the hernia.

Hernia Sac Handling

• The hernia sac is identified
• Bulging intestine or fatty tissue is pushed in the abdomen carefully.

Defect Measurement

• A precise measurement of the opening (abdominal wall defect) is done.
• Helps identify the proper size of mesh.

Mesh Placement (Key Step)

• A mesh of synthetic (polypropylene or composite mesh) is laid in the abdomen over the defect.
• The mesh is also larger by at least 3 -5 cm on all sides to ensure strength.

Mesh Fixation Options:

• Tackers (titanium or absorbable)
• Transfascial sutures
• A combination of both
• Some cases use fibrin glue

Eradication of Equipment and Sealing

• Gas escapes through the abdomen.
• Instruments are removed
• Minor cuts are sewn or glued with skin.
• Sterile dressings applied

Total Duration: 45–60 minutes

Day-care or 1 night Hospital Stay

Benefits of Laparoscopic Repair

• Surgical cuts are small → less scarring.
• Less post-operative pain
• Faster return to work (5–7 days)
• Higher quality of visualisation of hernia.
• Reduced recurrence rate in big or recurring hernias.
• Appropriate in case of overweight patients.

Open umbilical hernia surgery

Open umbilical hernia surgery is a conventional and generally accepted type of surgeries during which a surgeon makes a small opening around the belly button to mend the hernia. It is normally selected in case of small to medium-sized hernias, patients who cannot undergo laparoscopy, or cases where mesh/suture repair is to be used.

When Open Repair is Recommended?

Open umbilical hernia repair is generally desired in case of:

• The hernia is small (<2–3 cm)
• The patient underwent several past abdominal operations.
• Access by laparoscopy is inappropriate.
• It has a prisoned or painful hernia.
• The patient would like to have a cheaper procedure that is less complex in terms of cost.

Repair of Open Umbilical Hernias (Step-by-Step)

Anaesthesia

• Latent period is usually done under general anaesthesia.
• Very small hernias are sometimes treated using local or spinal anaesthesia.

Incision

• Somehow a curved cut (2-4 cm) is made in a small area right below or around the belly button.

Exposure of Hernia Sac

• The surgeon carefully opens the hernia sac that has fat or intestine.
• The sac is distinctly isolated of all other tissues.

Hernia Reduction

• The contents (fat or bowel) are forced back to the abdominal cavity.
• The sac is cut off or shaved off as required.

Repair of the Defect

• Open repair takes place in two principal forms:

Small Defects (Less Than 2 cm) Suture Repair

• A powerful and resistant stitch is used to close the opening in the abdominal wall.
• No mesh is used
• Applicable to hernias that are very small and have a low recurrence risk.

Mesh Repair (Used when the defect is over 2 cm)

• A defect is reinforced by placing a synthetic mesh over or below the defect.
• Reduces risk of recurrence
• Meshing is normally secured with suture.

Closure of the Incision

• Sutures or skin glue are absorbable.
• A small dressing is applied

Total Time: 30–45 minutes

Hospitalization: Same day; overnight

Advantages of Open Umbilical Hernia Surgery 

• Simple and widely available
• Indicated with small and simple hernias.
• Less expensive than laparoscopic repair.
• Under local anaesthesia/spinal anaesthesia possible.
• Short operative time

Conclusion

Umbilical hernia repair is a painless and well-addressed operation that is considered safe and effective and yields long-term pain relief, swelling, and threat of complications including incarceration or strangulation. Whether it is done in an open procedure or laparoscopy, the surgery is intended to place the projecting tissues back in place, and reinforce the abdominal wall with the help of sutures or mesh. Provided with the proper planning of the surgery, the surgeons with experience and in a timely manner, the patients successfully recover quickly, with a minimum of discomfort and a small risk of relapse. The selection of the most appropriate method, whether open or laparoscopic one, depends on the dimensions of the hernia, the overall condition of the patient, and prescriptions by the surgeons. All in all, umbilical repair of hernias provides very good results and patients can resume normal day to day activities with increased comfort and confidence. When done at the early stage, it is one of the most successful and least complicated abdominal surgeries.

Umbilical hernia repair surgery India GetWellGo

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FAQ

1. Is it important to operate on all umbilical hernias?

• Not always. Hernias in children could be small and they could close it. In adults, it is advised to take surgery to avoid complication and enlargement.

2. Will I need a mesh?

• Mesh is most commonly suggested when hernias are larger than 2 cm in order to minimise reoccurrence. Hernias as small as these can be treated using sutures

3. Can the hernia come back?

• Recurrence is also uncommon, particularly with mesh. The risk may be increased by such factors as obesity, chronic cough, or heavy lifting.

4. Can I exercise after surgery?

• Light walking can be performed on the first day. Avoid heavy lifting and grueling exercise in 4-6 weeks.

5. How soon can I shower?

• The patients are able to shower 24-48 hours after surgery, depending on the type of dressing. Take the advice of your surgeon.