The hernia is a weakness or hole of the tummy button (umbilicus) or tissue around the umbilicus (paraumbilical).
Usually some internal fat or bowel can push through the weak spot/ hole making it bulge. This will most likely get bigger and become unsightly if not treated.
Sometimes fat or bowel gets caught in the hernia causing severe pain and vomiting (called strangulation or incarceration) and requires an emergency operation to deal with the problem.
You can be given a local or a general anaesthetic. The choice depends partly on which you prefer, and partly on what your anaesthetist and surgeon think is best.
In some cases when the hernia is relatively small and your general medical condition does not allow you to tolerate the stress of a general anaesthetic, the operation can be done under local anaesthetic.
Having a general anaesthetic means that you will be completely asleep during the operation.
Having a local anaesthetic means that you will be awake during the operation, you will feel that something is being done at the area of the operation but will not feel pain.
A cut is made near the tummy button. Any fat or bowel in the hernia is pushed back or removed. The weakness is mended/closed usually with strong stitches.
Another alternative is to reinforce the weak spot with a piece of synthetic material (mesh). This is usually done when the tissues around the weak spot are not strong enough to be stitched up together with strong stitches or when the weak spot is so big that it is impossible to close it with stitches alone.
The synthetic patch is placed on top of the weak spot and is stitched to the healthy tissues around it. Soon scar tissue develops above and under the patch and this makes it very strong and makes it less likely that the hernia can come back again.
The skin is then closed up, usually with invisible dissolving stitches.
The appearance of your tummy button may change after the operation and rarely may have to be removed, especially if the hernia is large.
Keyhole surgery for hernia repair is rare. There is no clear evidence at the moment that it offers a significant advantage compared to the traditionally performed operations.
You may well be able to have the operation on the day you come in and go home the same day. Some people may need to stay in for a day or two depending on your health.
We do not recommend waiting and seeing if you have more trouble or not with this sort of hernia.
The hernia may get worse and may strangulate. A truss will not usually hold the hernia back in place. It is useful as a stop-gap until you have the operation. It is occasionally a good idea if you do not like the idea of an operation, or if you are not fit enough for one.
If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs.
The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are rare and seldom serious. If you think that all is not well, please let the doctors and the nurses know.
Bruising and swelling may be troublesome, particularly if the hernia is large. The swelling may take four to six weeks to settle down.
Serious bleeding that might require another operation to stop it happens in less than 1% of cases.
Infection happens in 1 to 2% of cases and usually settles down with antibiotics in a week or two.
The infection can cause more trouble in situations where the hernia was repaired with a synthetic patch.
The patch is a foreign body and if it gets infected it makes it difficult to control the infection with the antibiotics. If this happens, you may require antibiotics for a longer period of time and, very rarely, you might need another operation to remove the patch. In this case, you will most probably need another operation in the future to repair the hernia again.
Extremely rarely (1 in 2000 cases) the bowel or other organs of the abdomen can be damaged during the operation and if this occurs you will need another operation to fix the problem.
Aches and twinges may be felt in the wound for up to six months.
About 1 to 2 % of patients experience some pain longer than that (chronic pain) and if this happens the doctors will you discuss with you the best way to deal with the problem.
Overall the chances of the hernia coming back again are between 3 to 5%.
The chances of the hernia coming back are higher if the hernia was very big, you are overweight or your tissues are not very healthy and they are not healing well for example if you are elderly or diabetic.
Complications are rare and seldom serious.