Umbilical hernia

Synonyms in the broader sense

• Umbilical hernia
• external hernia
• Hernia

English: umbilical hernia

Medical: umbilical hernia

definition

The umbilical hernia (medical: the umbilical hernia) is a special form of an intestinal hernia. This is defined as the exit of viscera (usually fatty tissue and small intestine) from the abdominal cavity through a congenital or acquired gap that is located in one of the supporting layers of the abdominal wall.
To be able to speak of a hernia (umbilical hernia), several characteristics must be given:

1. a hernia, a weak point in the wall of the abdominal cavity
2. a hernial sac that exits through the hernial port and contains the sliding peritoneum
3. the contents of the hernia, which often simply consists of the large network or broken water, but in individual cases can also contain movable abdominal organs such as parts of the small intestine

In which Umbilical hernia it is a protuberance through a gap in the abdominal wall in the area of ​​the Belly button is located.
It often occurs right after the birth in infancy, as the abdominal wall around the navel is often not fully developed at this time. But umbilical hernias are also not infrequently found in adults, which are usually caused by increased stress on the abdominal wall and have a more severe course than in young children. Umbilical hernias with a relatively small hernial port carry the risk of entrapment (incarceration) of abdominal organs, which then causes considerable discomfort. This is why an umbilical hernia is usually operated on in an adult.
There are many different techniques available, whereby the selection of the suitable technique depends on the Size of the umbilical hernia, the activity of the patient and his general health.

Epidemiology / incidence in the population

About every 20th hernia, about 5% of all hernias, is a Umbilical hernia. Women and babies are particularly affected (3% of babies are born with an umbilical hernia, and up to 75% of premature babies!)

The probability of an entrapment is approx. 30%, whereby 10 to 15% of the affected patients die here. In small children, the umbilical hernia almost always heals spontaneously without any form of therapy, but in adults it practically never heals, which is why no surgery should be performed.
In about 3% of cases, a new umbilical hernia occurs after the operation.

causes

The area around the navel represents a congenital weak point in the abdominal wall because there is a gap between the left and right straight abdominal muscles, which is only caused by the fascia of the oblique muscles Abdominal muscles which consists of connective tissue.

In newborns, the cause of an umbilical hernia is that the abdominal wall is often not fully developed.

In adulthood, increased stress on the abdominal wall can lead to the development of an umbilical hernia.
These include, for example:

• Sports
• lifting heavy weights
• Obesity
• pregnancy (Please also read: Umbilical hernia in pregnancy)
• Diseases that cause increased water retention in the abdomen or the flu that is accompanied by a severe cough

All of these factors cause the pressure in the abdomen to increase so much that the weak point around the navel can no longer withstand it.
This is why the peritoneum bulges, often accompanied by a large mesh (a fat store in the abdomen; medical: Greater omentum) or parts of the Small intestine, between the straight abdominal muscles.
Even people with one Connective tissue weakness have an increased risk of developing an umbilical hernia in their lifetime.

Symptoms

The symptoms in patients who have an umbilical hernia can be quite right differently be. In this context, the Expression of the umbilical hernia a crucial role. In most cases it causes a Umbilical hernia neither in children nor in adults problems.

Nevertheless, complaints of varying severity can also occur. One of the most common symptoms of umbilical hernia is the appearance of abdominal pain (Stomach pain). These abdominal pains show up depending on the extent of the disease in different intensity. In most cases, however, the localization of the complaints is limited directly to the Umbilical region. In addition to the typical abdominal pain, there is an individual differently pronounced tumor in the area of ​​the navel One of the most noticeable symptoms of the umbilical hernia. In many cases, however, this lump is so minor that the patient concerned does not notice it for a long time. In these patients it is only getting under Exposure to high pressure on the Abdomen (e.g. when coughing, lifting) to a significant eversion of the intestinal loops and an accompanying enlargement of the tumor.

Classic situations, in which the umbilical hernia can be recognized as such in these patients, are during the Cough and des Bowel movements. In addition, a visible lump can be considered permanent symptom present or recede while lying down. In such cases it is one repositionable umbilical herniathat can often be treated without surgery. The so-called “Irreplaceable” umbilical hernia In contrast, it does not recede while lying down and usually needs to be promptly surgically are supplied. Both that Appearance of pain, as well as the Creation of a visible protrusion of the navel are classic symptoms of the umbilical hernia, but this clinical picture can also develop without any subjective symptoms. In such cases, the affected patients report only one Pull in the umbilical region, which increases in intensity with physical exertion and almost completely subsides at rest.

Is it due to the formation of the umbilical hernia Pinch off (Incarceration) individual intestinal sections, the symptoms perceived by the patient change within a very short time. Clamping the intestinal loops results in a Decrease in blood flow which ultimately leads to that Tissue dies. Clinically, this means that the patient has the image of a so-called "Acute abdomen" offers. Classic symptoms of the acute abdomen are sudden, severe abdominal pain that has a different location depending on the cause. Depending on the extent of the underlying disease, the abdominal pain can be limited to one region or extensive radiate. In addition, if there is such a pronounced umbilical hernia with clamped intestinal loops, the abdominal cavity usually appears as "Hard as a board". The affected patients may also develop pronounced general symptoms such as Fever, chills, nausea and / or vomiting develop. If the affected patient does not find a suitable one in a timely manner operative treatment initiated to shift the affected intestinal sections back, it can lead to a life-threatening state of shock come.

If pain occurs in the area of ​​the umbilical hernia following an operative correction, this is usually as harmless to interpret. In the first few days after surgery, you can use mild pain relievers such as Ibuprofen or Paracetamol be taken. In the case of severe pain, the attending physician can, at the patient's request, stronger Painkiller (for example Novalgin) prescribe.

Many patients also complain weeks after Umbilical hernia surgery or occasional pain. Especially with To lift heavy objects, to cough or Sports there is an increase in pressure in the abdomen. In this way, the tissue that has already been irritated by the operation is stressed and Pain triggered. Affected patients should view these pain phenomena as an indication that they are too high load has taken place.

A Umbilical hernia requires a long recovery period even after surgical relocation. Especially that Lifting heavy loads and excessive sport activity should be avoided within this period. As a rule, the body clearly shows which type of stress is too much and from which point in time full capacity is restored.

Umbilical hernia surgery

With umbilical hernia Operations one differentiates fundamentally two methods: a open procedure or a Laparoscopic procedure.
A laparoscopy is a Laparoscopy with special tubular instruments, which are called Endoscopes are designated. With the help of these instruments, one is then able to look into the abdominal cavity.
When to use which method depends on the type of umbilical hernia. In principle, it's one arched cutwhich the surgeon does. The Hernia sac back into the abdomen relocated. Then the further procedure depends on the size of the hernial sac.

• Open procedures:

For umbilical hernias with a Diameter of 2 cm and patients without Risk factors for a new umbilical hernia, one usually chooses the open procedure with a direct seam closure of the breakhole. The direct method can outpatient be performed.

Should it be having an umbilical hernia larger fracture hole act, you usually choose one different technique, since the probability of a repeated umbilical hernia is then up to 50%.
In this case you choose a method with one Plastic mesh, which consists of polypropylene. The network is brought in using a certain technique that is Sublay technique is called. That's where it lies Mesh between the abdominal wall and the peritoneum. You should also make sure that the hernial orifice overlaps by at least 5 cm so that there is no repeated break.
The net is then cut as small as possible. In principle, the operation must be carried out in a general anesthetic and stationary respectively. The patient can be discharged from inpatient treatment after about four days. After the operation, it should be noted that moderate movement how, for example, walks can start again at the beginning. Heavy physical work on the other hand should first after three to four weeks to be resumed.

• Laparoscopic procedure:

During laparoscopy, over small openings of the tissue instruments inserted into the abdomen. The laparoscopic procedure is used at larger umbilical hernias prefers.
The first step will be initially Adhesions the abdominal wall loosened. You have to be particularly careful not to injure the surrounding intestines.
Also here is now a Net inserted which is attached with seams and staples. The network knows one special coating on. To prevent repeated umbilical hernias, one must also ensure that the edges overlap by 5 cm.
You also need one for the operation general anesthetic With inpatient treatment. For follow-up treatment, a Belly band be worn and a steady Diet structure occur. The abdominal bandage prevents further complications such as accumulation of wound fluid and bruises.
Inpatient treatment usually ends five days after the operation. Again, a easy mobilization take place immediately and after three to four weeks again physically heavy work.
Surgical complications:
A possible complication from the plastic nets is the formation of Accumulation of wound fluid and Bruising. In addition, there can be a inflammation the surgical wound come.
The most dreaded complication is one renewed umbilical herniawhich should be prevented by overlapping the plastic net. In principle, however, the incidence of repeated umbilical hernias has been significantly reduced through the use of nets in contrast to direct sutures.

Duration of the operation and sick leave

At a Umbilical hernia (Umbilical hernia) it is a protrusion of intestinal loops, which can then be recognized as a raised skin next to the navel. As soon as there is pain in this area and as soon as the elevation turns bluish, you must see a doctor immediately because the umbilical hernia should be operated on to prevent the intestinal contents from dying off.

One is enough for smaller fractions local anesthesia (Local anesthesia), for larger fractions a general anesthetic be initiated. Accordingly, the duration of the operation is also very different.

At a small umbilical hernia the patient can usually still do so after the operation on the same day leave the outpatient clinic. The operation often does not take longer than an hour and so the patient can go home after only two hours, provided that no complications arise.

At a larger break, which must be surgically removed under general anesthesia, the patient should still one night for surveillance Stay in the hospital because general anesthesia always involves certain risks.

In case of Complicationsthat however very rare the duration of an umbilical hernia operation can also be longer.

To 10-12 days the sutures are then pulled in both surgical cases if no self-dissolving sutures were used.

For patients who do not have a physically demanding job, the patients receive a Sick leave of about 2 weeks (Depending on the complaints, possibly longer). Patients with hard physical work (e.g. construction work) can also be on sick leave for longer.

Mesh implantation for an umbilical hernia

At a Umbilical hernia there is a bulging of the intestinal contents. This can only happen if the Abdominal wall is too weak to hold the intestinal contents. With little trained Abdominal muscles and overweight (obese) Patient or also at pregnant women is an umbilical hernia (Scar hernia) therefore not infrequently.

In most cases it should have an umbilical hernia operated on become. To do this, an incision is made along the navel, giving the surgeon an open view of the umbilical hernia. The bowel loop is now put back in its old place. Then usually a Mesh between the abdominal muscles curious; excited. This net is usually made of plastic, with polypropylene being preferred. The surgical wound is then sewn up again.

The advantage of this network is that the Relapse rate (Relapse) enormously lowered can be. In the past, most patients who have had an umbilical hernia will have an umbilical hernia again within the next few years. The net is the chance of getting a relapse almost zero has been lowered.

Operation costs

A Umbilical hernia surgery (Umbilical hernia surgery) is always a medical emergency if the umbilical hernia starts to hurt or if there is a bluish discoloration. In this case, there is a risk of dying off the restricted intestinal contents, which then leads to a life-threatening shock condition can lead.

The Umbilical hernia surgery costs are from the statutory health insurance companies have now taken over. However, it is possible that additional contributions are required for some health insurance companies, especially if it is not an emergency operation.

The cost of a simple operation adds up to 64,70 €. An outpatient operation costs around € 75, depending on the doctor performing the procedure. The anesthesia amounts to approx 30€, for outpatient anesthesia, an additional € 5 is added to the € 30. This means that an inpatient operation including anesthesia costs just under € 100, while an outpatient operation with outpatient anesthesia costs the umbilical hernia operation 110€.

Surgery in children

A Umbilical hernia (Scar hernia) arises due to a weak point in the connective tissue connection between the Abdominal muscles. Circa 3% of all children get an umbilical hernia during their childhood. At Premature baby the probability increases to scarce 75%.

Especially if the child screams or presses the stomach tightly, one can see a bulge in the stomach area. The umbilical hernia often regresses in children by the age of three. Therefore, an umbilical hernia is rarely operated on in children.

Insecure parents can try to gently push the contents of their intestines back into their child's stomach. As long as the umbilical hernia can be moved back into the abdomen without any problems and as long as the child does not feel any severe pain, there is no indication for an operation.

However, the child did strong pain, vomits or it is evil, you should go to the emergency room to get the umbilical hernia operate otherwise the affected intestinal area can die.

An operation should also be considered for children who still have an umbilical hernia after they are three years old. Basically the Operation similar to that of adults also. The abdominal wall is opened, the bowel loop is brought to the right place and the surgical incision is sutured. The installation of a net is usually not necessary for children. As with adults, the operation can be carried out on an outpatient basis.

Pain after surgery

The Umbilical hernia surgery (Umbilical hernia) is usually onbulant performed under local anesthesia. The anesthesia (a general anesthetic in the case of inpatient admission is also possible) is the patient painless during the operation (analgesia). The patient can leave the clinic after just 2 hours.

Nevertheless, pain can occur after the operation of the umbilical hernia. However, these pains are not abnormal and arise due to the injury of superficial (peripheral) annoy on the skin surface and in the area of ​​the fat and muscle tissue. Especially with Tension in the abdominal muscles it can lead to increased pain. Most of the time, however, the pain disappears within few days again.

Still, one should avoid unnecessary abdominal muscle contractions and above all that Avoid lifting heavy objects because the pain then becomes more intense again.

Chronic postoperative pain, however, is not to be expected.

Symptoms in Children

The Leaving individuals Intestinal sections through the abdominal wall in the form of an umbilical hernia is a phenomenon that can be observed very often in children. The likelihood of developing an umbilical hernia is included in children about 3 percent. Premature babies with a birth weight of less than 1500g even suffer with a probability of 75 percent an umbilical hernia within the first few years of life. It is generally believed to be a Umbilical hernia in children can regress spontaneously by the age of three without medical intervention. The umbilical hernia in children is expressed in most cases by the development of a visible lump during the Crying or defecating. In contrast to adults, acquired vulnerabilities play within the Abdominal wall plays a subordinate role in the development of the umbilical hernia in children. Acquired forms of the umbilical hernia also arise in children through a Divergence of the connective tissue, however, are rather rare. When an umbilical hernia develops in a child, it usually occurs during the pregnancy to a defective closure of the former Exit point of the abdominal organs (embryonic development of the gastrointestinal tract). This innate weak point can then be followed by a Pressure rise within the abdomen Intestinal sections step out.

In most cases, children do not need to have the umbilical hernia taken care of until they are three years old. The Rate of spontaneous regression is up to this point very high. However, the umbilical hernia forms in children up to the age of three not completely and permanently back, must be a surgical treatment should be considered. In addition, it can also cause umbilical hernias in children Pinching of individual intestinal sections and an accompanying one Reduced blood flow to the intestinal tissue come. In such cases, parents of affected children often notice that the hernial sac can no longer be pushed back. In addition, the affected children develop strong ones cramping abdominal pain. Also the appearance of more pronounced nausea and or Vomit is not uncommon. Parents of affected children should note in this context that it is a medical emergency that is potentially life threatening. For this reason it is imperative that a Pediatrician visited become. If individual sections of the intestine are clamped due to the presence of an umbilical hernia urgent a operative care respectively.

During the classic Umbilical hernia surgery the hernial sac that has formed is moved back into the abdominal cavity and its passage point is then moved with the help of Seams between connective tissue and Abdominal muscles locked. This form of surgery can be used in children both stationary as well as outpatient be performed. The decision on the most suitable variant should be made jointly by the attending physician and the parents. Regardless of the chosen Surgical method The affected children usually recover quickly from the procedure. An umbilical hernia in children also has one in the event of a need for surgical treatment very good prognosis.

Umbilical hernia in the baby

Suffering one Umbilical hernia with a baby every fifth baby on. In premature infants, the umbilical hernia occurs in four out of five babies. Fortunately heals the umbilical hernia in babies mostly by itself and has one very good course.

In the majority of the observed cases, an umbilical hernia in infants is caused by the The embryonic umbilical port remains open. Nevertheless, it can also be pronounced in babies weakness the membrane closing the umbilical port or the muscular abdominal plate be causative. In most cases, the umbilical hernia in the infant can be considered completely harmless. Similar to toddlers and adults, the presence of an umbilical hernia in babies can be recognized by the noticeable protrusion of the navel. In many of the infants the hernial sac occurs in the form of a hemispherical approximately cherry-sized bulge from the navel. Although the umbilical hernia is harmless in infants, it should definitely be one Pediatrician visited and one physical examination be performed. If the treating pediatrician decides that no medical treatment is necessary, the umbilical hernia should still be reported by the parents observed become. In most cases, the umbilical hernia in babies tends to develop within the first few years of life spontaneous, completely without medical intervention to regress. Treatment is usually not necessary if the umbilical hernia occurs in the infant only while screaming and bowel movements shows and this problem-free manually relocated can be. In most cases, viz The umbilical hernia regresses spontaneously without therapy. This is due to the fact that the Abdominal muscles increase and the fraction becomes smaller and smaller. However, if there is a steady increase in the size of the umbilical hernia in the infant over the course of the disease and / or the hernial sac cannot be put back in by hand Abdominal cavity relocate and it comes to a breakage entrapment, must be an emergency operative treatment be performed. In addition, an umbilical hernia that causes severe pain in the infant should always be treated surgically. Walk in infants Umbilical hernias rarely accompanied by pronounced symptoms. The majority of children are affected by the presence of the Intestinal eversion not affected at all.

Causes of an umbilical hernia in babies:
The babies affected are one enlarged umbilical ring, through which the umbilical hernia can develop. This can eventually result in yourself Tissue bulging out of the abdomen. Usually, in the first few days after the birth, the Umbilical cord residues fall off and the umbilical ring begins to shrink. So an umbilical ring is something natural. In babies with an umbilical hernia, the only thing missing was the subsequent adequate reduction in size of the umbilical ring.

There are also other causes. An umbilical hernia can also be caused by a Disturbance in wound healing of the navel arise and also with excessive use of the abdominal press by crying or coughing of the babies.

The therapy depends on the one hand on whether Parts of the intestine in the umbilical hernial sac lie or not and whether the umbilical hernia really regresses over time. So the pediatrician should regular look at the umbilical hernia throw. The pediatrician will feel the umbilical hernia and listen to the umbilical hernia with a stethoscope. With this method he can hear whether there are intestinal parts in the hernial sac. This would be the case with chuckling, splashing noises. Intervention in the case of an umbilical hernia would be necessary in the second age if the width of the hernia is still over 1 cm. Also would be intestinal parts located in the hernial sac a reason for an intervention. If there are intestinal parts in the hernial sac that are trapped, a Undersupply these intestinal parts what a Die this entails parts of the intestine. Therefore, surgical therapy is carried out immediately.

The operative therapy is outpatient and in general anesthetic, however, the child can usually go home on the same day and it is a small, usually uncomplicated operation.
During the surgery the surgeon closes the umbilical hernia with a suture. Furthermore, one should make sure that the surgical wound is not too strong in the first few weeks physical stress is exposed. Otherwise there is a risk of another umbilical hernia.

Umbilical hernia in pregnancy

In the pregnancy the umbilical hernia usually arises from an increased Pressure in the abdominal cavitywhich can tear the abdominal wall in sensitive areas such as the navel.
The Abdominal muscles pushed apart by the pressure. The umbilical hernia in pregnancy is also expressed here by a Bulging of the navel. In principle, the umbilical deepening has elapsed during pregnancy, only if there is also a protrusion, it can be an umbilical hernia.

In most cases, the umbilical hernia during pregnancy does not cause any further symptoms.
Only if one Entrapment of intestinal parts if the hernial sac is present, you should also operate if you are pregnant. An entrapment can be recognized by Pain of pregnant women in this area and one Discoloration of the spot.

The pain can be drawing and burning, sometimes the umbilical hernia also goes with it Vomit and nausea hand in hand. The discoloration is due to the lack of blood flow to the intestinal parts due to the entrapment. In any case, it is one emergency.

However, pregnant women usually do not need to worry, the umbilical hernia being pinched during pregnancy rarity. In the course of pregnancy, the umbilical hernia remains in most cases symptomless.
During birth also arises from the umbilical hernia no danger for infants or pregnant women. After the delivery, the umbilical hernia often regresses on its own. There are also special ones gymnastics, which can be useful when the umbilical hernia regresses.
If the umbilical hernia does not resolve on its own, the usual procedure takes place operative therapy depending on the size of the umbilical hernia.

Sports

By strong physical strain When lifting weights or exercising, the pressure in the abdomen and the tension in the muscles can increase so much that Pain arise.

A harmless umbilical hernia in which no entrapment (Incarceration) of the organ sections in the hernial sac can become problematic through exercise and excessive stress. Exercise also increases the risk of such entrapment developing.
However, a patient suffering from an umbilical hernia should not completely refrain from exercising. Especially the Art and intensity physical stress is crucial.

After a successful Umbilical hernia surgery physical activity should be kept low for the time being. Heavy lifting and sports are strictly prohibited, especially within the first few days after the procedure.
If this is not observed, various complications can arise:

• Tearing the seams,
• Wound healing disorders
• Strength Secondary bleeding.

In addition, the entire Operation result be at risk from exercising within the first few days after surgery. For this reason, affected patients are advised to exercise excessively and especially to exercise dispense until the sutures can be removed.
This is usually about ten to twelve days the case.

After removing the sutures, the patient is allowed to start doing light sports. Ideally, a slow increase stress takes place until the patient in question has regained his normal level.
Exercising after umbilical hernia surgery should always be done pain-dependent respectively.

If there is no pain during or after exercise, then there has been no overuse. If the patient feels pain (or other symptoms such as nausea) during exercise, the sport must be started immediately canceled become. It usually goes by until an athlete is fully able to exercise again after surgical correction of the umbilical hernia some weeks.