A hernia results when there is a gap in the muscles of the abdomen. This allows the membrane lining the abdomen to protrude, along with some of the "insides"- usually fat or intestine. Occasionally, the "insides" can get stuck in the gap, causing incarceration, which can sometimes progress to strangulation (cutting off of the blood supply to the part that is stuck). These complications are rare; most hernias just cause discomfort and interfere with normal activity. All hernias tend to enlarge with time. They never get better on their own.
An umbilical hernia occurs in a gap under the belly button which many people are born with (if you have an "outie," you have an umbilical hernia). It is less common for umbilical hernias to develop complications than it is for groin hernias.
The only treatment for a hernia is surgical repair. Not all hernias need to be fixed; but if it is causing symptoms, a hernia should be treated.
Hernia repair is done as an outpatient, usually under local anesthesia (numbing of the area by injecting medication) with sedation (medication given intravenously by the anesthetist to make you drowsy). The local anesthesia lasts four to six hours, allowing you to go home and take some pain medication before the incision gets uncomfortable. The sedative given by the anesthetist keeps you pleasantly drowsy during the operation - you may even doze during the procedure - but will wear off rapidly afterward. If the hernia is very large, you may need general anesthesia(to be put to sleep), or spinal anesthesia (in which anesthetic is injected through the spine, numbing the lower part of your body).
WHAT TO EXPECT:
At the operation, you will walk to the operating room with the nurse anesthetist. After you are comfortable on the bed, you will be hooked up to an EKG monitor and given some oxygen. A small needle will be put in a vein in your hand or arm, and the sedative will be given. If general anesthesia is used, you will go to sleep. Otherwise, you will feel drowsy. The nurse will wash off the hernia area. the surgeon will then put some sterile sheets around it. Unless you have general anesthesia, you will be able to talk during the operation. The surgeon will then inject the local anesthetic, which will cause some stinging for five or ten seconds. The area will then be numb. You will be able to feel some pushing and tugging while the surgeon is working, but it shouldn't hurt; if it does, you will be able to let us know so we can inject some more medication. Many people actually fall asleep and snore during the operation!
The surgeon will make a one to two inch incision over the hernia. The bulging "sac" will either be removed or tucked in and the muscles stitched together over the weakened area with permanent suture material. In some cases, it may be necessary to place a plastic mesh to reinforce the repair, and the surgeon will inform you if this is done. After repairing the hernia, the skin is closed with dissolving stitches or metal staples. A dressing is applied.
After the operation, you are wheeled back to the recovery room. The incision should not hurt much. After the sedative wears off, you will be sent home. You should have a prescription for pain medication.
Over the next few hours, the incision will start to sting and ache gradually. You should take the pain medication before it bothers you too much, and try to keep ahead of the pain (but do not take more than the prescribed dose). An ice pack may help for the first 48 hours; after that, warm packs are best. It is good to move around frequently; otherwise you will get stiff. The area is likely to hurt a bit more each day for two days; then it should get better steadily. There is likely to be some swelling and bruising. This is normal. If it seems excessive, you should call the office.
The risks of umbilical hernia repair are small. There is always a chance that the hernia may recur. This is more likely to happen with frequent heavy lifting, coughing, cigarette smoking, or if you are overweight. Recurrence happens about 5 to 10% of the time.
Read the booklet and pre- and postoperative instructions. Make sure all your questions are answered before the operation. The more you know about it, the easier the whole experience will be!
BEFORE THE OPERATION
1. Shower daily with Hibiclens soap for at least two days prior to the operation, to reduce the risk of infection.
2. Do not take aspirin, bufferin, anacin, advil, nuprin, or similar medications within a week of the operation. Tylenol (acetaminophen) is OK.
3. If you take any other medications, check with us about taking them before the operation. In most cases, we will want you to continue.
4. Do not eat or drink anything (except for your medications, which you may take with a sip of water) after midnight before the operation.
AFTER THE OPERATION:
1. Any activity which does not cause pain is OK. No heavy lifting or other strenuous activity for six weeks. Walking, driving, swimming, sex etc. are all right in moderation if the incision does not hurt.
2. There is normally more soreness each day for the first two or three days, and then it should start to get better. Some swelling and bruising is normal, but if it seems excessive or if the incision looks infected (red, hot, tender, and swollen), call.
3. Leave the dressing on for at least 2 days. It can then be peeled off. If there is a little bleeding under the dressing, this is normal. If there is much drainage, you may remove it and replace it with a dry gauze dressing. Call if there is much bleeding or drainage.
4. Avoid constipation; take anything you like to treat the problem (milk of magnesia, mineral oil, Ex-Lax, prunes, etc.).
5. Take the pain medication as prescribed; do not avoid taking it - you will not become addicted in the short time it is needed and it is very important to remain as comfortable as possible.
6. Make an appointment to see your surgeon 2 weeks after the operation.
