How is umbilical hernia surgery performed?

An operation to remove an umbilical hernia is indicated for children and adults who have encountered a congenital or acquired pathology. This disease is diagnosed in 3% of newborns against the background of intrauterine disorders and poor tissue fusion after removal of the umbilical cord. In adults, such an ailment occurs against the background of muscle weakness and with high physical exertion, when intra-abdominal pressure rises.

Hernia repair is performed as planned, an operation on an umbilical hernia is prescribed from the moment the disease is detected in adults, and in children under 6 years of age, attempts are still being made to conservative treatment. In 85% of newborns, a hernia is reduced on its own if parents follow a preventive regimen, do gymnastics with the child, turn to a nutritionist and gastroenterologist to select an effective symptomatic treatment.

Removal of an umbilical hernia in adults is always carried out, because the protrusion will no longer be reduced on its own, unlike children who have active growth and formation of muscle tissue.

Everyone should be operated on without exception when there are complications. It can be infringement, peritonitis, intestinal obstruction, internal bleeding. Under such conditions, the internal organs die off, and after a few hours of the pathological process, it will no longer be possible to restore their structure and function.

An umbilical hernia in women can cause infertility, when necrosis and inflammation occur during infringement, and the infection spreads to neighboring organs, including the ovaries and fallopian tubes.

Indications for urgent surgery

Urgent surgery to remove an umbilical hernia in adults has the following indications:

1. infringement . This is a life-threatening condition that leads to intoxication of the body, impaired local blood flow, pulmonary and cardiovascular insufficiency. A strangulated hernia can cause death. This complication is manifested by acute pain in the abdomen, an increase in education and the inability to set it in the wrong place. The protruding navel becomes dense and hard to the touch.
2. To intestinal obstruction . Stagnation of feces in the large intestine without regular emptying leads to necrosis and peritonitis. This condition often causes sepsis, blood poisoning with a fatal outcome.
3. Embryonic hernia . Removal of an umbilical hernia and an operation to eliminate the consequences of such a congenital anomaly are performed on the first day after birth.

In other cases, in the absence of contraindications, hernioplasty is performed as planned, taking into account the needs of the patient and the severity of his condition. In some cases, the removal of the protrusion should be carried out as soon as possible in order to prevent complications.

Technique

Umbilical hernia repair is performed by several methods, but the most commonly used is the Liechtenstein operation with the installation of a mesh implant. Herniotomy is done under local or conduction anesthesia by chipping the skin around the navel.

Preference is given to local anesthesia, because after the conduction the patient's condition is somewhat worse, he is worried about nausea, dizziness, weakness, problems with memory and attention.

The intraperitoneal removal method is indicated for embryonic hernia in newborns. During the operation, the surgeon opens the hernial sac, returns the organs to their place and removes excess tissue. If the contents of the hernial sac are not resorbed embryonic tissues, they are also removed. After all manipulations, the tissues are sutured in layers.

Mayo plastic surgery is performed for adults and children over 5 years of age. The operation can be performed with the removal of the umbilical ring, which must be discussed with the patient before the intervention.

An umbilical hernia repair begins with a skin incision just above the navel. Then the surgeon allocates the hernial sac, restores the anatomy of the abdominal cavity, removes excess tissues, sutures the defect in layers, closing it with his own tissues. In case of an uncomplicated umbilical hernia, the operation is performed with the installation of a mesh implant, which grows together with the tissues, preventing the organs from protruding through the umbilical ring.

Rehabilitation after Mayo plastic surgery is long, the patient needs to wear an inguinal bandage for more than a month, regularly go for dressings, follow a strict diet, and exclude physical activity. These are standard preventive measures after hernia repair, but when closing the defect with one's own tissues, they are of particular importance, because the risk of recurrence of the disease is much higher.

The mesh is an additional and reliable protection against prolapse of organs, but own tissues can disperse during high physical exertion and with an increase in intra-abdominal pressure. Frequent coughing, bloating and constipation will be factors in the appearance of a relapse of the pathology.

Laparoscopic surgery is indicated for the removal of an umbilical hernia in children and adults in the absence of complications.

Almost always, this method of hernia repair is combined with the installation of a mesh implant. The use of a laparoscope makes it possible to exclude a postoperative hernia of the abdomen, because there is no wide scar left on the abdominal wall, which in other cases will contribute to the occurrence of pathology.

Contraindications

An umbilical hernia is not operated on when there are the following contraindications:

1. Acquired hernia before the age of 5 years. There is a possibility of self-reduction of the protrusion. But this applies only to an uncomplicated disease that does not cause discomfort to the child.
2. In the second half of pregnancy . Hernia repair will be stressful for the body, which will undesirably affect the health of the child. The operation, in the absence of complications, is postponed until the birth of the child or, if possible, until the end of the breastfeeding period.
3. Severe pathologies of the cardiovascular and respiratory systems . Pathologies such as heart attack, varicose veins, thrombocytopenia will be absolute contraindications to surgery.
4. About acute inflammatory processes, infections during an exacerbation, virus carrying .
5. Chronic incurable diseases at any stage when there is a risk of deterioration of the patient's condition.
6. Renal failure, diabetes mellitus, complicated liver cirrhosis.

Most of the contraindications will be relative restrictions to the removal of an umbilical hernia, and each case is considered by the surgeon on an individual basis.

Preparation

Before hernia repair, special preparation is required, including the sanitation of infectious and inflammatory foci in the body, as well as the exclusion of contraindications and risks. A month before the planned operation, the patient undergoes a series of examinations. The surgeon will need the results of blood and urine tests, ultrasound images, the conclusion of a gastroenterologist, oncologist and gynecologist.

A week before the operation, the doctor will cancel some medications. Drugs that thin the blood, anticoagulants can affect hernia repair.

Before hernia repair, you need to undergo the following studies :

• electrocardiogram;
• esophagogastroduodenoscopy;
• x-ray of the abdominal organs;
• Ultrasound of the stomach;
• fluorography.

Postoperative period

The first two weeks after the operation, a sparing regimen is prescribed. The patient is discharged from the hospital on the 2-7th day, depending on the surgical technique performed. The therapeutic diet is shown for the first 3 weeks, after which you can return to your usual diet with minor changes.

The postoperative bandage is prescribed for a month, but its long-term wearing will be determined by the doctor, because recovery in the early period does not exclude the occurrence of ventral abdominal hernia. When there is a risk of postoperative hernia or recurrence of the umbilical cord, the supporting corset should be worn longer, alternating it with therapeutic compresses.

The bandage is also important in order to reduce pain by reducing the load on the muscles of the anterior abdominal wall. If the pain after hernia repair remains a constant symptom, this may indicate complications, and then the corset will be useless and even harmful.

When a month has passed since the operation, you can gradually return to an active life, include new foods in the diet and engage in physiotherapy exercises.

In the early postoperative period, there is a risk of the following complications:

• infection  - after hernioplasty it happens extremely rarely, because this is a “clean” operation, but patients over 60 years old, when a lesion is detected, antibacterial drugs are prescribed for prevention;
• neuralgia - damage to the nerve endings occurs in 10-17% of cases, while the patient is worried about burning, soreness, loss of sensitivity and itching in the area of ​​​​the surgical scar, this disorder often disappears on its own after 4-7 months, while the nerve endings are restored;
• intestinal obstruction - after the operation, stagnation of feces occurs, therefore, in the early period of rehabilitation, patients are shown laxatives, breathing exercises and drugs to improve peristalsis;
• seroma  is swelling of tissues in the operated area, more often occurs after the installation of a mesh implant, as a reaction to a foreign body, the formation resolves on its own after 1-3 weeks.

There are about 15 cases of complications per 100 operated patients. Surgeons, due to the high risk of consequences, strongly recommend abandoning attempts to self-treat a hernia and agree to surgery as soon as possible.

The prognosis largely depends on how much time it takes to prepare for the operation. As soon as the doctor makes a conclusion, it is worth comparing the importance of hernia repair with its risks, and after listening to several specialists, agree to remove the hernia with fewer risks.