Umbilical Hernia is a common condition in infants in which the intestine protrudes or pokes out through the abdominal muscles in the navel area, where generally the Umbilical cord is located. Umbilical Hernia is generally harmless if not sore and is evident when the bellybutton protrudes. During childhood, Umbilical Hernia closes on its own, but sometimes when it does not, it might require a surgical correction during adulthood. This condition is commonly seen in premature babies and can be diagnosed through physical examination alone.

Symptoms

Umbilical Hernia causes swelling or bulging near the navel and is generally visible under normal circumstances. However, in some cases, the protrusion occurs only when the baby strains, coughs or cries. Though this condition is painless, it can cause discomfort during adulthood. To avoid complications, it is advisable to seek professional help even if the condition initially seems harmless. There might be symptoms of pain, swelling, discoloration, and tenderness in the navel, accompanied by vomiting sometimes.

Causes

When the fetus is still unborn and in womb, the umbilical cord passes abdominal muscles of the baby through a small opening, which generally closes post birth. But in case muscles fail to completely join the midline of abdominal wall, this condition appears post birth, and sometimes later in life.

During adulthood, when there is too much pressure on the abdomen, it leads to this condition. This pressure might build up due to a number of causes like multiple pregnancies, obesity, previous abdominal surgery, ascites (fluid in the abdominal cavity), and long-term dialysis for kidney function.

Complications

Complications might be caused when the protruding part of the intestine gets incarcerated or trapped and fails to push itself back into the abdominal cavity, reducing the blood supply. This leads to tissue damage and umbilical pain. If the blood supply totally fails, tissue death leads to gangrene, causing infection, and posing a life-threatening situation. In such cases, surgery might have to be performed in an emergency.

Treatment

Most of the times, abdominal tissue pushes itself back but sometimes, it has to be done by an experienced medical professional. When this cannot happen, surgery has to be performed to correct the situation. The surgery can be open or laparoscopic.

A small incision is made at the base of the bellybutton during surgery, which is a small and quick procedure. The hernia is corrected and sutures close the incision. For adults, sometimes mesh is used for strengthening the abdomen during open surgery.

Take Away

Umbilical Hernia is a condition in which the intestine or abdominal tissue protrudes through the abdominal muscles in the navel area, where generally the Umbilical cord is located. It is a harmless condition but sometimes painful. Generally, it corrects itself but when it fails to do so, corrective surgery is required which can be open or laparoscopic.

 Umbilical Hernia - How To Manage It?

Umbilical hernia refers to a condition where your intestine protrudes through the opening of the belly button. This condition generally affects infants, but some people may suffer from it in adulthood as well. Umbilical hernias are common but do not cause any health issues in most cases. However, in some instances, the disorder leads to problematic symptoms.

Symptoms of umbilical hernia:

If you or your child suffers from the symptoms mentioned below, you should seek treatment.

  Pain
  Nausea/vomiting
  Discolouration and swelling at the region of the hernia

If one or more of these symptoms appear, seeking treatment at the earliest is necessary to avoid further complications.

Complications from umbilical hernia:

Even though complications from the disorder are rare in infants, they are not unheard of. The most common complication occurs when the portion of the intestine protruding from the belly button is trapped. In such a case, blood supply to this region is cut. This can lead to tissue death or gangrene. The infection slowly spreads to the rest of the digestive system, causing a life-threatening situation.

Adults who have umbilical hernia are more likely to suffer from complications of the condition.

Treatment for umbilical hernias:

Treatment differs based on the age of the patient. In most infants, the umbilical hernia does not produce any symptoms. In fact, such hernias typically disappear on their own after a year or two. A doctor may also be able to push the hernia in during a routine check-up. However, you should not try to do this yourself.

When is surgery needed for an umbilical hernia?

An infant requires surgery for the hernia if he/she experiences the following traits-

  Pain
  The hernia has a diameter larger than half an inch
  The hernia is large and does not decrease in size in the first two years of the child s life
  Does not disappear even when the child reaches the age of four
  The external portion of the intestine sticks out and gets trapped.

However, in the case of umbilical hernias affecting adults, a doctor will always recommend surgery to avoid possible complications arising from the disorder.

How is the surgery performed?
For both infants and adults with an umbilical hernia, the surgical procedure remains the same. The surgeon makes a small incision at the base of the belly button. The doctor uses this opening to return the external part of the intestine inside the abdominal cavity. Once this is complete, the doctor stitches the incision.

In adults, a supportive mesh is also used to ensure that the intestine does not protrude once more through the belly button.

Laparoscopic hernia repair is suitable for all types of a hernia such as an umbilical hernia. Just like an inguinal hernia, A camera is placed into the abdomen through the muscles. Two small incisions are made for the operating instruments to get through. This is followed by the cutting of the tissue that is placed between a hernia and the intestine. The hole thus gets exposed. Through one of the laparoscopic ports, the hernia mesh gets rolled and is placed into the abdomen. A hernia is then pulled up and the mesh gets secured with 4 sutures. A special device is used to fix healthy muscle.

Umbilical Hernia - Everything You Should Know About It!

An inguinal hernia refers to the condition when tissues, such as those which are a part of your intestines, find a weak spot in your abdominal muscles and protrudes outwards. This may often result in a painful bulge, especially at times when you bend over, lift heavy objects or cough.

Usually, if the hernia is small, your doctor might just ask you to wait and leave it untouched. In children, manual pressure may also be applied to reduce bulging. Enlarged or very painful hernias, however, require surgery for the prevention of complications and for relieving discomfort.

Generally, there are two types of hernia repair surgeries which are as follows:

1. Open hernia repair surgery: This type of surgery is carried under sedation by local anaesthesia, and ensures an incision being made in the groin to push back the protruding tissues into the abdomen. The weakened area is then sewn back, and reinforced with the help of a synthetic mesh, a procedure called hernioplasty. The opening is then closed down using staples, surgical glue or stitches. Though movement as soon as possible is recommended, exertion must be avoided.

2. Laparoscopy: This is a kind of minimally invasive surgery, done with the aid of local anaesthesia. In this procedure, multiple small incisions are made in the abdominal region and then gas is used in order to inflate it, to make visibility easier.

A tiny camera is attached at the end of a small tube (a laparoscope) and then inserted into the cavity created by the incision. With the aid of the increased visibility facilitated by the camera, the surgeon then inserts other tiny instruments through the remaining incisions for repairing the hernia, with the help of a small synthetic mesh.

This kind of surgery allows your surgeon to avoid the scar tissue which might be present from a hernia and which might have been repaired earlier. Laparoscopy is thus also recommended for those with bilateral hernias (on both the sides).

However, research has shown that this kind of repairing may also increase the likelihood of recurrence or some other complications or risks.
Risks are usually reduced when the surgery is performed by a surgeon who has a lot of prior experience in the same.

Inguinal Hernia Treatment

Hernia refers to the condition when an organ or fatty tissue inside the body begins to protrude from its location. Hernias are mostly detected in the groin, belly, or the stomach region. They occur because of muscle weakness in the said region where it is detected but they can be treated with surgery. In most cases, a surgery is prescribed and laparoscopic hernia repair is a very popular surgical procedure that has proven to be successful in most of the cases. This is why a growing number of patients decide to go for it.

Laparoscopic hernia repair: procedure: In this surgical procedure, a laparoscope (an instrument with a high-resolution camera and high-intensity light) is passed inside the abdomen through small incisions that varies between 0.5 and 1.5 inches in length. When the laparoscope moves inside the abdomen, it sheds light on the hernia and sends the images to the monitor connected to it. The surgeon views the hernia on the monitor and then the abdominal cavity is made to swell with carbon dioxide so that the surgeon can find enough space to operate the hernia. Once this is done, the surgeons operate the hernia with tiny surgical instruments. Once the hernia is removed, space or the hole is covered with a mesh from inside the abdomen.

Advantages of laparoscopic hernia repair: The laparoscopic procedure is popular because it is comfortable for the patient in many ways. They have to endure lesser post-operative pain as compared to open surgery, which means the recovery is quicker. They require lesser drugs for healing and the patient can get back to work in fewer days. It is an advanced form of surgery and thus, gives better results.

Disadvantages of laparoscopic hernia repair: While the non-invasive laparoscopic surgery has several advantages, it also comes with some drawbacks. It is lengthier in comparison to open surgery and also costs more. It cannot be performed by all the surgeons and only those who are skilled in this type of surgery can do justice to the different cases of a hernia. 

Recovery after laparoscopic hernia repair: The patient takes one to two weeks after the surgery to return to light activity and daily routine. Nevertheless, heavy exercise and strenuous activity should be avoided until four weeks after the surgery. The full recovery time differs from patient to patient depending on their age, gender, and health condition but one month is the average time for full recovery.

555 Manish Technique for inguinal hernia repair:

Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports.

555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.

Laparoscopic Hernia Repair - What Should You Know

When an organ residing in a cavity such as the abdomen tries to push through the muscular layer it resides in, it is called as hernia. 

Though said to be genetic, hernias can be caused by things such as improper heavy lifting, incorrect posture, or chronic constipation and as a result of surgical complication or injury. Factors like obesity, pregnancy, smoking, chronic lung disease aggravate the severity of the hernia. It is believed that about 27% of all males and 3% of females can have a hernia during their lifetime.

Types of hernias:

Inguinal hernia: The groin is the most common area, where the abdomen pushes through a weak spot in the lower abdominal wall, causing a protrusion into the inguinal canal. This is more common in men than women.

Hiatal hernia: The abdomen has the diaphragm separating it from the thoracic cavity in the upper border. When it pushes through the diaphragm, a hernia is caused and there is almost always associated food reflux in these cases. Though the most common cause is associated old age, due to muscle weakness, there also are cases of congenital hiatal hernias.

Umbilical hernia: The abdomen finds a weak layer along its length and protrudes through the skin on the stomach. Most commonly seen in babies around the bellybutton, it gradually corrects itself on its own. Quiet rare in adults, seen during pregnancy and in chronic obese people.

Incisional: These are post-surgical, and happen when the organ protrudes through the weakened wall due to surgery. The abdomen is again the most common area and the hernia can happen either onto the external surface or internally, when they are called ventral hernias.

These are the most frequent types, though hernia affects other organs like the spine, brain, appendix, etc.

Treatment
 
This includes a combination of constant monitoring followed by a decision to do surgical treatment. Hiatal hernias and umbilical hernias can be monitored for a while before deciding on surgery. Inguinal hernias may require surgery earlier in the stage. Post-surgery, a mesh is placed to hold back the tissue in its corrected place. The umbilical hernia in children could be self-limiting. If it does not get auto-corrected in the first year of life, that also would qualify for a surgical treatment. Hernias need to be managed under medical supervision.

Hernia - What You Should Know About It?

A hernia occurs when a weakened area of muscle in the abdominal wall gives way and the internal organ/tissue bulges out through this weakened are or  defect'. This can happen in many different areas of the abdomen. A hernia that develops in the groin region is called "inguinal hernia". It may be very painful especially if a part of the intestine gets trapped in the bulge.

The only treatment option is surgical repair as the weakened area "defect" needs to be repaired and will likely need reinforcement by a prosthetic material called a "mesh". Doctors may resort to Open Surgery or Laparoscopic Inguinal Hernia Repair depending on his/her evaluation of the patient. 

Who is a candidate for Laparoscopic surgery?

Laparoscopic surgery is the preferred treatment option for most people with inguinal hernia. Special situations in which laparoscopic surgery is much superior to open are

  Failure of a previous open surgical repair. Laparoscopic surgery is performed from "behind" the hernia and abdominal wall in comparison to open surgery which is performed from "the front". So, in case of failure of the open surgery, laparoscopic surgery is done through a fresh, non-scarred area and is technically safer and easier than doing an open surgery once again.

  If there are hernias on both sides and both need to be repaired at the same time, laparoscopy has a great advantage as both the hernias can be tackled and repaired through the same three tiny cuts, and two separate large incisions need not be made. 

Who is Not a Candidate for Laparoscopic Surgery?

The person is not a candidate for Laparoscopic Surgery if he has:

  Some patients who have undergone previous Abdominal Surgery or prostate surgery may not be suitable candidates for laparoscopic inguinal hernia surgery.

  Some underlying medical conditions, that make him unfit for general anaesthesia, as usually laparoscopic surgery can only be done under general anaesthesia.

How Laparoscopic Inguinal Hernia Is Carried Out?

In a Laparoscopic Intervention, two to three small incisions are made in the lower abdominal area. The laparoscope is passed through one of these incisions and the surgical instruments are inserted through the other incisions. The abdominal cavity is inflated using Carbon Dioxide to help the surgeon visualize the lower abdominal area clearly. Using the laparoscope, the surgeon visualizes the Hernia and uses long instruments to operate on it. She covers the hernia with a mesh and may fix the mesh to abdominal muscles using either stitches or stapler-like instruments.

Benefits of Laparoscopic Surgery

1. Two or three tiny cuts (5-10 mm in size), hence there is less pain after laparoscopic surgery

2. Better cosmetic results

3. Quicker recovery

4. Early return to daily activities like walking, working, etc

5. Shorter hospital stay 

Role of Laparoscopic Surgeon In comparison to many other minimally invasive surgeries:

Laparoscopic Inguinal Hernia Repair is more demanding in terms of technical capability of the surgeon. In general, Laparoscopic Inguinal Hernia Repair is more difficult to carry out in obese people than others. However, if the doctor is well trained and technically advanced with long experience, he can carry out such minimally invasive surgeries smoothly irrespective of the BMI of the patient. Everybody is not a candidate for Laparoscopic Inguinal Hernia Repair.

It is the doctor who decides if a particular patient is suitable for such surgery or not. However, the conclusive factor in any such repair is the experience and expertise of the doctor. This is why there are not many Laparoscopic Surgeons who carry out Laparoscopic Inguinal Hernia Repairs. Owing to the complexity of this procedure, it is important to get it done from an expert surgeon only.

Laparoscopic Inguinal Hernia Repair !

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