Umbilical or paraumbilical hernia

What is an umbilical or paraumbilical hernia?

These are swellings found in or around the belly button. They can be present from birth or develop over time and sometimes occur after pregnancy. Smaller ones usually contain a small amount of fat and can be left alone if not causing symptoms. Large ones can cause discomfort and are often felt to be unsightly.

Surgical repair

The LSG specializes in hernia surgery in London, Hampshire and Surrey. Repair can be with strong sutures alone or with a synthetic mesh to reinforce the tissues if the defect is greater than 1-2cm in size. Often this is most simply performed through a small cut underneath the tummy button where it will be least visible.

Open hernia repair – This is used in small uncomplicated hernias. The incision is usually underneath the belly button. The tummy button will be repaired but will not return completely to normal. Large complicated umbilical hernias may require removal of the belly button. Recovery time will depend on the size of the hernia. Dissolvable sutures are used to repair the skin and a waterproof dressing placed over the wound.

Laparoscopic (keyhole) repair – This is rare and usually reserved for specific situations e.g. a recurrent hernia when a mesh has been used previously. Small cuts are made in the abdominal wall to allow the passage of the instruments. The hernia is repaired using synthetic mesh and keyhole fixation devices. The cuts are repaired with dissolvable sutures and a local anaesthetic is given. A waterproof dressing is placed over the sites so you can shower straight away. These should be left for 5 days. On removal, if the wound is not dry, another dressing should be applied for a few more days.

More information on Laparoscopic Surgery

What happens prior to surgery?

The secretary and hospital will organise a day for the procedure and give you the admission details. Routine blood tests and a heart tracing (ECG), maybe required before admission. You will be asked not have anything to eat up to six hours prior to surgery. Water can be taken up to 2 hours prior to the surgery. The surgeon will go through the procedure again with you on the day and take your consent. The anaesthetist will also visit to discuss the general anaesthetic and your post-surgery pain relief. It is also not uncommon for patients to require anti-sickness medications after a general anaesthetic.

How long will it take for me to recover from surgery?

Straightforward hernia repair is usually performed as a day procedure. You will be discharged once you are fully mobile and comfortable. Most patients require 2-3 days of simple pain medication but should be fully functional during this period. Some patients return to work after this, but it will depend on the type of repair and your occupation.

Which medications will I require after surgery?

You will be discharged from hospital with a supply of simple pain-killers with instructions on how to use them. Regular paracetamol is particularly effective and can be combined with an anti-inflammatory (ibuprofen) or codeine-based drug (dihydrocodeine). Anti-inflammatories are not suitable for all patients and should be taken with food. The codeine-based drugs can cause constipation and should be taken with plenty of fluids.

When can I return to work?

Generally, it is recommended to take 2-3 days off work for straightforward repairs. Your ability to return to work will depend on your job and varies between individuals.

When can I return to normal activities?

Day to day activities including light lifting can begin immediately after surgery provided you are comfortable. Strenuous activities (heavy lifting, weights in the gym, HIIT training, contact sports) should be avoided for 6 weeks and reintroduced in a stepwise manner. There are usually no restrictions on lifestyle or activities after a hernia has been repaired once recovery is complete (beyond 6 weeks).

When can I drive?

Driving should be avoided in the first week after surgery. Once you can perform an emergency stop in a stationary vehicle and turn to view your blind spot then driving should be safe. It is preferable to contact your insurance company to check for any specific instructions they may have.

What are the risks?

Straightforward repair carries a low risk of the hernia returning (2%). Large hernia repairs can collect fluid around the surgical site after the operation. This is called a seroma. If it is sterile and not causing discomfort, it is better left as it will resolve with time. Infective complications are uncommon and usually treated with a course of antibiotics.

Who do I contact if there are concerns?

The group practice telephone is answered in working hours and messages can be left out of hours. Any concerns will be relayed directly to the consultant surgeon on receipt. The hospital ward also provides a 24/7 means of contact. They will contact the consultant about any concerns and are able to give advice if required.

For more information on hernia surgery in London, please contact us on Davies@londonsurgicalgroup.co.uk