Operation

• Patient with a hernia opening > 5-10 mm
• Non morbidly obese patient
• 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.

A prosthesis with a diameter from 4 to 9 cm, depending on the defect in the abdominal wall, is inserted through the hernia opening into the abdomen. It can be placed in the abdomen behind the abdominal muscle wall or behind the abdominal wall in front of the peritoneum (membrane which surrounds all the organs in the abdomen). The hole above the prosthesis is then closed with sutures. When treating an umbilical hernia, the belly button is fixed to the abdominal wall with a thread.

What is a biphasic prosthesis/mesh?

A biphasic mesh has 2 sides. An upper side of polypropylene silk. Scar tissue will form through and around the openings in the mesh/prosthesis, causing it to be incorporated into the adjacent tissue. This forms a mechanical barrier against pressure and prevents hernia recurrences.
A smooth side on the bowel side that reduces the risk of the prosthesis adhering and growing into the bowel.

If the prosthesis infects and does not respond to antibiotic treatment, it may be necessary to remove the prosthesis / mesh.

A prosthesis is made of polypropylene with the following characteristics :

• Non absorbable
• Non carcinogenic
• Non allergenic
• Resistant to mechanical stress

How long 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 /mesh is needed.

What should one do to prevent a hernia recurrence 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 hernia recurrence.

Recurrence of an umbilical or epigastric hernia:

Incidence : < 4,3 %

Risk factors for recurrence:

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

Infection mesh / prosthesis

Incidence : < 1%

Wound infection

Incidence : 9,2 %

Seroma / fluid effusion:

Incidence :  6,5 %

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

Chronic pain:

Chronic pain after 2 years : +/- 5%

94% have no pain symptoms after 2 years.

Bowel injury:

< 1,5% when adhesions between bowels and the sac are loosened.

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 of < 35 kg/m2 (body mass index (weight kg/height2)

– 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 with mesh or prosthesis.