What is it?

Umbilical herniae smaller than one centimetre can simply be repaired with a few stitches, but larger hernias are best reinforced using a mesh (prosthesis). This prosthesis may be placed through open surgery or keyhole surgery.

Types of treatment

Laparoscopic repair of umbilical herniae

For larger umbilical herniae, incisional herniae after a laparoscopy or recurrent umbilical herniae, we generally opt for laparoscopic hernia repair at the Maria Middelares Hernia Centre in Ghent. However, sometimes there are good reasons to perform the surgery in the classical way and in that case, the surgeon will discuss this with you in the pre-operative consultation.

Keyhole surgery for umbilical hernia repair allows for the placement of a large prosthesis. It is important for the prosthesis to be properly fastened to the abdominal wall with staples. These staples will secure the prosthesis to the abdominal muscles. This may be quite painful during the initial post-operative period, especially when sneezing or coughing (as this causes the muscles to contract). Good pain relief therefore is important during the first few days after a laparoscopic repair of an umbilical hernia.

For a laparoscopic hernia repair, a prosthesis is used that is soft on one side to prevent fusion with the bowel. If you wish, your surgeon can show you the mesh during the pre-operative consultation.

Robot-assisted laparoscopic umbilical hernia repair

In September 2016, the Maria Middelares Hernia Centre in Ghent was the first European centre to offer robot-assisted laparoscopic hernia repair. Our surgeons began using this method after undergoing extensive training in the United States, where 5% of all umbilical hernia repair procedures in adults are robot-assisted.

The procedure is essentially the same as the traditional laparoscopy, but the instruments and the camera are operated by the surgeon from a console.
At the Maria Middelares Hernia Centre in Ghent, we use the latest generation of the Intuitive DaVinci Xi robot. Dr Muysoms now trains European surgeons in this latest innovation in abdominal wall surgery. Together with other surgeons performing robot-assisted umbilical hernia repair, an innovative technique was developed at the Maria Middelares Hernia Centre in Ghent, where the prosthesis is not placed in the abdomen but rather between the different muscle layers. This new technique, termed TARUP (transabdominal retromuscular umbilical prosthesis), retains the advantages of keyhole surgery but avoids placing the prosthesis so that it comes into contact with the bowels and avoids the painful fastening with staples.

Open umbilical hernia repair

At the Maria Middelares Hernia Centre in Ghent, we mainly opt for open surgery directly through the navel for herniae whose diameter measure under two centimetres. A laparoscopic procedure will be proposed for larger herniae. For an open umbilical hernia repair procedure, we generally use a round umbilical hernia prosthesis that is placed beneath the abdominal muscles through the navel. For this procedure, the maximum size of the mesh is 8.4 cm in diameter. As most meshes will shrink a little over time, such a Ventral Patch is not recommended for herniae of more than two centimetres.

Possible complications

Umbilical hernia surgery generally is a safe procedure and serious complications are rare. Possible complications are listed below. The list is not exhaustive but contains the most frequent complications:

  • Bruises, wound infection and wounds opening up
  • Bleeding of the abdominal wall or navel; this sometimes requires another operation.
  • Infection of the prosthesis.
  • Accidental injury of the bowel or other abdominal organ.
  • Change from keyhole surgery to an open procedure.
  • Complications that are not directly caused by the surgery: pneumonia, bladder infection, heart rhythm disorders, etcetera
  • Complications associated with general or epidural anaesthesia
  • Over the long term, the surgical site will remain painful for some patients

Some side effects occur very frequently and are no reason for concern:

  • Fluid accumulation

    After the operation, a swelling often remains for a few weeks where the umbilical hernia was located. This is fluid accumulation (also termed seroma) that usually is not painful but often causes patients concern. This swelling is a normal side effect of the operation. It will slowly disappear of its own accord. If, in exceptional cases, the fluid accumulation causes pain, the surgeon may decide to drain it.
  • Bruise

    Another common side effect is bruising around the wound. This is no cause for concern either, and it will spontaneously disappear in the weeks following the operation. In case of doubt or concern, feel free to contact your GP or our department.

Can an umbilical hernia recur?

A mesh placement reduces the risk of a recurrent umbilical hernia, but it cannot be entirely ruled out. This is because the mesh we use may shrink a little, causing the weakened area in the abdominal wall to expand. This means that approximately 10% of patients will develop a new umbilical hernia in the area around the navel. These are often small and do not require a second procedure. However, if a new umbilical hernia becomes bigger and/or is painful, a new repair is required with a bigger prosthesis. About 1 in 20 patients (5%) will need to undergo a second procedure within the ten-year period after the umbilical hernia repair.

Aftercare

Umbilical hernia operations can be performed in the day clinic for most patients. If necessary, admission for one night will be arranged. It is important that you are active and move around lot as soon as possible after the operation. For three weeks after the procedure, we do recommend that you avoid lifting heavy loads and intense exercise. You will also be given a belt that you may wear in the first weeks for support.
After the check-up with the surgeon, three weeks after the operation, you will be able to resume all activities again including lifting and sports.
When you are discharged from the hospital, we will ask you to visit your GP ten days after the procedure to have your wound checked and your sutures removed. In case of problems, you (or your GP) can of course always contact our department.

How much does an umbilical hernia repair cost?

The Maria Middelares Hernia Centre in Ghent charges the official RIZIV prices. The invoice will be sent to you by post after a period of approximately three months. In addition to the surgeon's and anaesthesiologist's fee, this will display the general charges for hospital admission and the use of materials such as the mesh.
As is the case in almost any hospital, there is an additional charge for the use of a single room. At the Maria Middelares Hernia Centre in Ghent, this additional charge is a maximum of 150% of the official price. No additional charges are added to the fee if a multiple-occupancy room is chosen.

Centres and specialist areas

Hernia Centre
General Surgery

Latest publication date: 05/02/2021
Supervising author: Dr Pletinckx Pieter