Umbilical hernia – epigastric

What is an umbilical hernia – epigastric hernia ?

An umbilical hernia is an incomplete closure of the abdominal wall at the level of the umbilicus. It may be congenital and present at birth or develop later in life as a result of a slow weakening of the abdominal wall at the level of the umbilicus.

During pregnancy, the foetus’s intestines develop outside the uterus. Before delivery, the intestines migrate into the abdomen. The last part of the abdomen to close is the umbilicus. If the wall does not close, a congenital umbilical hernia occurs.

• A slowly increasing swelling at the level of the umbilicus.
• Intermittent pain when the fatty tissue gets stuck in the hernia opening. The pain disappears when the fatty tissue slides back into the abdomen.
• In case of entrapment or obstruction of the bowel in the umbilical hernia, it may no longer be possible to push the bowel back into the abdominal cavity. The pain may then increase and may sometimes be accompanied by bloating, nausea and vomiting. An intestinal obstruction is a surgical emergency and requires emergency admission.

• An umbilical hernia can occur during pregnancy due to the growth of the foetus and the associated increasing pressure in the abdominal cavity.
• If a hernia is symptomatic and detected during pregnancy, surgery will be performed after pregnancy if possible, except in case of acute symptoms (persistent pain, bowel obstruction).
• If a non-symptomatic hernia is detected before a possible pregnancy, the patient is warned that the hernia may increase during pregnancy and become symptomatic.
• If a hernia is small and asymptomatic, a wait-and-see attitude can be adopted and wait for the natural evolution.

There is no single explanation for the development of a hernia, but there are many factors.

• Smoking: this weakens the molecules (collagen) that give strength to all tissues.
• Genetics: Some families have weaker tissues.
• Rare genetic disease: Marfan syndrome, Ehlers-Danlos syndrome.

Manual labour has not been shown to increase the risk of a hernia.

No.

→ Newborn

An umbilical hernia can close spontaneously during the first two years. If it has not closed after two years, surgery is recommended.

→ Adult

No, the opening will not close spontaneously.

Whenever the pressure in the abdomen is increased (coughing, lifting a heavy weight or physical exertion), the pressure will try to escape through the opening of the hernia, the point with the least resistance. As a result, over time, the opening will widen.

If a hernia is symptomatic, surgery is suggested. Unless the patient’s general condition does not permit surgery.

If a hernia is asymptomatic, the decision depends on the patient’s age, size of the abdominal wall defect, general condition and physical activity.

→ To a young, active patient, surgery will be suggested.

→ To an older, not very active patient, a conservative approach may be suggested as long as no symptoms are present.

+/- 19% of non-symptomatic umbilical and epigastric hernias that initially did not undergo surgery will still undergo surgery at a later stage.

Technique:

Open umbilical and epigastric hernia repair with mesh

In open umbilical epigastric repair with mesh, the hole in the abdominal wall is closed and reinforced with a prosthesis/mesh.

Which patient?

→ Thin patient.

→ Patient whose general condition does not permit general anesthesia.

→ Hernia opening > 1cm.

See surgical procedure: Open Umbilical – epigastric hernia repair with mesh

The umbilical – epigastric opening is closed with sutures, without placing a prosthesis/mesh.

Which patient?

→ Thin patient.

→ children.

→ Patient whose general condition does not permit general anesthesia.

→ Herniated opening </= 1cm.

See surgical procedure: Open umbilical and epigastric hernia repair with primary sutures

The umbilical/epigastric opening is closed and reinforced with a prosthesis/mesh placed laparoscopically.

Which patient?

→ Young active patient with obesity.

→ Obese patient.

→ Large hernia opening > 2cm.

See surgical procedure: Laparoscopic umbilical and epigastric hernia repair