tUmbilical hernias are very common in newborns and the good news is that almost all will disappear spontaneously by the age of five years and very rarely is surgery required.
What is an umbilical hernia and why does it occur?
The umbilicus is a congenital area of weakness in the abdominal wall. This represents the area where the umbilical cord connected the baby to the mother when she was in the womb.Normally, except for the point where the cord is attached, the defect closes down at birth with further shrinkage in size of the defect due to growth of the abdominal muscles towards the umbilicus.
This closure occurs by five years of age in almost 95% of all children. So an umbilical hernia is pretty common and may occur in around 20% of all newborns.
Doctor, does she require to be operated then?
In majority of the children we do not advise any surgery except to wait and watch for spontaneous, natural closure of the umbilical defect. However surgery is indicated if:
- The hernia does not close down spontaneously by five to six years of age.
- There is an episode of obstruction of the hernia – What this means is that normally abdominal contents like bowel, omentum, etc move freely in and out of the umbilical defect. Sometimes however, they can get stuck and become trapped outside the abdomen. Why this occurs is not known but can convert a simple situation to a dire emergency! The child will cry excessively due to pain, if we touch the affected area, the child cries even more and the hernia will look tense, red and inflamed. The child may even throw up.
- The underlying defect in the abdominal wall is > 1.5 cm in diameter.
- When there is excessive protrusion of the abdominal contents with redundant skin and it looks like an elephant’s trunk (proboscis).
- When the child has an underlying condition like some rare syndromes or if there is increased amount of fluid in the abdomen (e.g. when the child is undergoing peritoneal dialysis).
How should I prepare my child for surgery?
Actually the operation will be done even before you know it. Please refer to Preparing your child for day care surgery
During repair of umbilical hernia, we take a small incision below the navel, identify the hernial sac, disconnect it and close the peritoneum and then close the fascial defect. We may need to refashion the skin to give a good cosmetic result in children with large hernias.
- In the immediate postoperative period please follow the General postperative instructions.
- The child will have a small dressing over his navel.
- The child may have some difficulty in passing urine in the first 24-48 hours after surgery. He may hold his urine back. Even if the child does not pass urine until the morning after surgery it is OK. If the child does not pass urine beyond this then please contact me.
- Give sponge baths to the child in the first 48 hours after surgery. You can come in for a follow up visit to me after 48 hours.
- Follow up: In general, I call the child back for inspection of the wound on the second day and for suture removal on the seventh postoperative days.
- In children with large umbilical hernias, there may be some swelling and hardness around and under the wound due to accumulated fluid and blood for a period of up to a month after surgery. This slowly gets re-absorbed back into the body and skin becomes soft and supple again.