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Umbilical Hernias
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Incarcerated umbilical hernia

What is an umbilical Hernia?  An umbilical hernia is a hernia where the bulge comes through the belly button or umbilicus.  The umbilicus is a natural point of weakness in the abdominal wall.  It may get stretched by weight gain or pregnancy and so is prone to develop a hernia.
 
What are the symptoms?  The hernia may at first show up as a painless bulge.  Over time it may become larger and painful to the touch.  If a hernia becomes large enough it may thin out the overlying skin which then may break down, creating a wound.  At first it may be reducible which means that the bulge goes away when you lay down or relax.  At this time it only comes out when your cough, sneeze or strain your abdomen.  Over time the hernia may become incarcerated.   This means that the bulge remains regardless of what you do and can not be pushed back in.  If the hernia progresses beyond this point it may become strangulated.  Similar to putting a rubber band around your finger, the tissue inside the hernia sac is at risk for dying because of a loss of blood supply.  The mass becomes more painful and the overlying skin may become red, swollen and warm.  Depending on what is in the hernia the person may develop fevers and difficulty moving his bowels or passing his urine.  This a surgical emergency and medical help should be sought immediately.
What is in my hernia?  When a hernia is small it may just be some fluid or fatty tissue.  As the hernia enlarges it may contain bowel or other organs.  Usually in this kind of hernia preperitoneal fat is caught in the hernia.
 
How do you treat a Hernia?  A hernia is a protrusion through a physical defect in the wall of the abdomen.  It will not get better over time or heal itself.  It must be repaired with surgery.  Today a hernia is typically repaired using a patch made of plastic, similar to patching a hole in a tire.  At one time hernias were repaired by simply closing the hole with sutures; however, this has been shown to have a much higher rate of failure and so recurrence of the hernia. Umbilical hernias may be repaired using either an open technique or a laparoscopic technique.  Using the open procedure the surgeon makes an incision around or near the umbilicus to reduce the hernia and repair the defect.  In the laparoscopic procedure the surgeon inflates the abdomen and then uses a special telescope and instruments to look inside the abdomen and repair the hernia. The incisions for the laparoscopic technique are tipically made in the side of the abdomen.
 
Should I have my hernia repaired?  Almost everyone who is healthy enough to undergo surgery should have it repaired.  Persons with significant health problems which would make surgery too dangerous may be better at using an alternative to surgery.  You should consult your Surgeon to see it this applies to you.
 
What are the alternatives to surgery?  Wearing a supportive garment such as an abdominal binder or truss may keep the hernia reduced and eliminate some of the symptoms.  If the hernia is incarcerated or strangulated then the above garment will not be helpful.
 
What are the risks of surgery?  Risks common to all surgeries are bleeding, infection and scar.  Despite the best efforts of your surgeon there is a very small chance of recurrence of your hernia.  This is much more likely should the hernia be repaired without mesh.  There is much less of a chance of recurrence should your surgeon use mesh.  Depending on the complexity of the hernia other potential complications may be present.  These may include in injury to bowel or other intra-abdominal structures and healing with adhesions that can lead to further surgery. 

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Incarcerated umbilical hernia

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Laparoscopic view of fat incarcerated in the umbilical hernia

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The abdominal wall defect once fat has been reduced

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The hernia has now been repaired with mesh

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615

J. Douglas Reid III, MD, FACS, 3 St. Francis Dr, Suite 490, Greenville, SC 29615