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Umbilical Hernia Repair

Surgical Reconstruction of Defects in the Umbilical Ring with Mesh or Suture Techniques

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Umbilical Hernia Repair?

Umbilical hernia is protrusion of preperitoneal fat, omentum, or bowel through a fascial defect at the umbilical ring; congenital in children (closes spontaneously in 90% by age 4–5), acquired in adults from increased intra-abdominal pressure.

Adult umbilical hernia repair is one of the most common general surgical procedures with annual incidence approximately 250,000 in the United States.

Surgical approach is determined by defect size, recurrence status, patient comorbidities, and surgical experience: primary suture repair, open mesh repair (preperitoneal Rives-Stoppa, retromuscular sublay, onlay), or laparoscopic IPOM (intraperitoneal onlay mesh).

Recurrence rates are 10–15% with primary suture repair and 1–5% with mesh repair for defects larger than 2 cm; mesh recommended for defects ≥1.5–2 cm and all recurrent hernias.

Symptoms

Visible bulge at the umbilicus, often increasing with cough, straining, or standing
Pain or discomfort at the umbilicus, especially with physical activity or after meals
Reducible swelling that disappears when supine or with manual reduction
Skin changes overlying long-standing hernia: discoloration, ulceration, thinning
Acute symptoms suggestive of incarceration or strangulation: severe pain, irreducible swelling, nausea, vomiting, abdominal distension
Strangulated hernia: tender, erythematous, irreducible mass with signs of bowel obstruction or peritonitis (surgical emergency)
Cosmetic concerns about umbilical appearance

Risk Factors

Pediatric: prematurity, low birth weight, African ancestry, Down syndrome, mucopolysaccharidosis (Hurler), Beckwith-Wiedemann syndrome
Adult: obesity (BMI >30), pregnancy, multiparity, ascites (cirrhosis, malignancy), chronic cough (COPD, asthma), constipation, prostatism with straining
Connective tissue disorders: Ehlers-Danlos syndrome, Marfan syndrome
Previous abdominal surgery with incisional hernia at umbilical port site
Diabetes mellitus, smoking, immunosuppression: increase recurrence and surgical site infection risk
Patients with cirrhosis and ascites have markedly increased complication and recurrence rates

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent bulge at umbilicus in child after age 4–5 or with defect >1.5 cm
  • Symptomatic adult umbilical hernia with pain, growth, or skin changes
  • Suspected incarceration or strangulation: severe pain, irreducible mass, nausea, vomiting, abdominal distension (urgent surgical evaluation)
  • Recurrent umbilical hernia after prior repair
  • Patient with cirrhosis and ascites with progressive umbilical hernia (especially before liver transplantation)

Treatment Methods

01
Preoperative evaluation: physical examination with reducibility assessment, BMI optimization, smoking cessation 4–6 weeks preoperatively, glycemic control, treatment of constipation and chronic cough
02
Imaging: ultrasonography or CT for occult or atypical hernias, large defects, recurrent hernias, or suspicion of complication
03
Anesthesia: local anesthesia with sedation for small primary repairs, general anesthesia for larger and laparoscopic repairs; regional anesthesia options available
04
Pediatric umbilical hernia: observation until age 4–5; primary suture repair via small infraumbilical incision (Mayo or simple) for persistent or symptomatic hernia
05
Adult primary suture repair: vertical or transverse fascial closure with non-absorbable suture for defects <1.5 cm in low-risk patients; recurrence 10–20%
06
Open mesh repair (preferred for defects ≥1.5 cm): preperitoneal sublay (Rives-Stoppa) or retromuscular mesh placement with overlap of 3–5 cm; lightweight macroporous polypropylene mesh; fixation with absorbable or permanent suture
07
Laparoscopic IPOM: intraperitoneal placement of composite mesh (with adhesion-resistant barrier, e.g., ePTFE-coated polypropylene), fixation with tackers and transfascial sutures; useful for obese patients and recurrent hernia
08
TEP (totally extraperitoneal) and eTEP techniques: emerging minimally invasive approaches with retromuscular mesh placement and reduced visceral exposure
09
Hernia in cirrhotic patients with ascites: optimize ascites with diuretics or paracentesis, consider TIPS preoperatively, consider repair before transplantation; high complication risk
10
Postoperative care: early ambulation, analgesia (multimodal, opioid-sparing where possible), avoidance of heavy lifting for 4–6 weeks, abdominal binder controversial
11
Complications: hematoma, seroma, surgical site infection (1–5%), mesh infection requiring removal (rare), chronic pain, recurrence
12
Follow-up: clinical assessment at 1–2 weeks for wound, 4–6 weeks for return to activity, 12 months for late recurrence

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.