Operation

• Children
• Patient with a hernia: < / =1cm
• Slim patients
• Patient whose general condition does not permit general anesthesia.

Technique

For an umbilical hernia, an incision is made usually in the contour following the skin crease of the lower part of the umbilicus. In an epigastric hernia, an incision is made above the bulge of the hernia on the midline.

In case of an umbilical hernia the belly button is first detached from the hernia or the abdominal wall. The hernia contents are isolated.

If the hernia contains intestine, it is pushed back into the abdomen.

If the hernia contains abdominal fat, it is removed. The opening in the abdominal wall is closed with sutures and when treating and umbilical hernia, the belly button is fixed to the abdominal wall with a thread.

How much time does the procedure take?

Depending on the size of the defect, the procedure takes 30 to 60 minutes.

The operation time is shorter if no prosthesis is needed.

What should one do to prevent a recurrence of the hernia after surgery?

For the first 6 weeks after surgery, do not play sports or engage in strenuous physical activities.

Avoid being overweight, as this increases intra-abdominal pressure and therefore the risk of a recurrent hernia.

Recurrence of an umbilical hernia / epigastric rupture after surgery:

Incidence : 8 – 14 %

Risk factors promoting recurrence:

• BMI > 30kg/m2
• Diabetes
• Smoking
• Wound infection
• Lung disease

Wound infection:

Incidence :  5,7 %

Seroma:

Incidence :  3,1 %

If a large hernia is removed or if part of the hernia sac remains, the void left after treatment of the hernia may be filled with abdominal fluid (seroma) and blood.

Chronic pain:

95% have no pain symptoms after 2 years.

Intestinal injury:

< 1,5% injury during loosening of adhesions.

Hemorrhage:

Rare, mostly due to bleeding from small vessels on the abdominal wall. In most cases, bleeding stops spontaneously.

To reduce the risk of complications, it is advisable to :

• Stop smoking for 6 weeks
• Have a BMI weight < 35 kg/m2 (body mass index (weight kg/height2)
  

– Bientzle  Acute and chronic pain after laparoscopic incisional hernia repair pp 233 -237

– K Jensen Mesh versus suture elective repair of umbilical hernia:systematic review and meta-analysis; BJS Open 2020;4:369 – 379

– European and Americas Hernia Societies (EHS and AHS) Guidelines  for treatment of umbilical and epigastric hernias from the European  Hernia Society and Americas Hernia Society; BJS 2020; 107: 171 – 190

– Nienhuijs Simon Mesh or Patch  for hernia on epigastric and umbilical sites ( Morpheus trial)

Normal symptoms

In normal conditions, pain is well controlled with paracetamol (Dafalgan®), NSAIDs (anti-inflammatories) or morphine (Tradonal®…) and pain symptoms diminish over time.

• Nausea and vomiting  (24-48 hours) may occur. Adolescents and especially young women are more affected.
• Hardening and pain at the level of the scar. The wound may feel hard for several weeks.
• Pain is often aggravated by sudden movements of the abdominal wall laughing, coughing, sneezing,….)
• Swelling at the site of the hernia after surgery (seroma): Collection of wound fluid and blood that fills the void left after treatment of the hernia.
• Bloating decreases in the weeks after surgery.
• Urinary retention may occur in the first hours after the procedure. Temporary placement of a urinary catheter may be necessary.
• On returning home, the joy of returning home, is often followed by an increase in fatigue and sometimes a drop in morale.

Abnormal symptoms

If certain symptoms seem abnormal to you contact your doctor

• If you have persistent fever
• If you have acute pain that increases over time
• If you have bloating with nausea and vomiting

If this is not possible, you can contact avec your surgeon.

If you are unable to contact your GP or your surgeon, go to the uremergency department at St Elizabeth Hospital in Uccle.

Sport / Physical activity

• After a rest period of 4 to 6 weeks, sports and physical activities can be resumed.

Pregnancy

Pregnancy is always possible after open umbilicus/epigastric hernia repair.