Definition:
A hernia of the umbilicus (belly button or navel) is a defect or hole in the abdominal wall at the level of the belly button.  Skin overlies the defect and it looks like a bulge at the belly button, especially when the child strains. The umbilical opening is a natural opening where the structures that make up the umbilical cord pass. The defect usually closes shortly after birth through natural processes. When the process of closure does not finish, there is a persistent defect in the abdominal wall, or an umbilical hernia. The bulge seen at the belly button is actually a piece of intestine or fat from inside of the abdominal cavity pushing through the abdominal defect.

Natural Course:
Most umbilical hernias will shrink and close spontaneously. Surgical repair is seldom performed in small infants and rarely recommended for children under three years of age. Spontaneous closure becomes unlikely after five years of age and surgical closure is then advised. Large defects often become smaller with time and become easier to repair with the growth of the child. When the opening is very large (1.5 to 2 cm) spontaneous closure is less likely and repair may be done in children younger than four years of age.

Diagnosis:
Diagnosis of the umbilical hernia is by history and physical exam. A bulge is seen at the umbilicus which is usually more apparent with straining. Your surgeon will be able to feel a defect in your child’s abdominal wall.  Although the bulge may be quite large, the abdominal defect itself is usually fairly small.

Unlike inguinal hernias which have a high risk of becoming incarcerated (having something stuck in the hernia), bowel only rarely becomes incarcerated at the umbilicus in young children.  Even very large bulges can disappear when the child relaxes and the herniated bowel falls back inside the abdomen. Should the bowel become trapped, swollen, and tender, however, emergency evaluation is important to avoid bowel injury and possible perforation and resulting serious illness. Appropriate surgical repair is critical to survival in this situation.  Most umbilical hernias are repaired on a non-emergency basis after age 4 or 5 years.

The operation:
The procedure involves a small incision in the skin fold above or below the umbilicus. The herniated bowel or fat is placed back into the abdomen and the fascial opening, or hernia defect, is closed with stitches.  Unlike adult hernias which are often closed with mesh (a screen like material), umbilical hernia repair in children is typically closed using only the child’s natural fascia and suture.  The skin is then closed with stitches which are buried beneath the skin and do not require removal (they usually dissolve within 2 weeks). Small paper tapes (Steristrips) usually cover the incision and should be left in place until your child returns for the post-operative visit. A clear adhesive bandage will be placed over the incision and may be removed after 48 hours. After recovering from anesthesia, children leave the hospital within a few hours of the procedure.

We have a team of surgeons, anesthesiologists, nurses and child life specialists dedicated to providing both you and your child with the best operative experience possible. We believe it is important to reduce pre-operative anxiety and to control post-operative pain and discomfort.

Postoperative care:
Medications:

• Pain control rarely requires more than over-the-counter pain relievers such as Children’s Tylenol or Children’s Advil. These may be given every four hours as needed at the dose recommended by your surgeon.
• Any other medications your child required before the operation should be continued on the regular schedule afterward.

Diet:

• Nausea following general anesthesia is uncommon in infants. However, older children may experience nausea after discharge. Initially, liquids may be tolerated better than solids.
• There are no dietary restrictions once the nausea has passed and your child is alert and hungry.

Activity:

• Small children require no restriction of activity following umbilical hernia surgery.
• They may have enough initial discomfort to limit their activity voluntarily for a day or so.
• Larger children should avoid contact sports for at least two weeks.

Wound care:
Always wash your hands before touching or cleaning the incision area. Some blood staining of the paper tapes on the incision is common. If the blood is dry and not spreading, the staining is not a problem. If the blood seems fresh, the amount is increasing, or if the paper tape is blood soaked and partially floating above the skin, apply gentle pressure with a clean washcloth for five to six minutes. If the bleeding does not stop after five minutes, call your surgeon at (602) 254-5561.

The clear plastic dressing covering the incision may be removed 48 hours after the operation. No other dressing or bandaid needs to be placed on the incision after this dressing is removed.

Bathing:
No tub baths should be given for at least two days after the operation. Sponge bathing for infants and showering for older children are permitted the day following the operation. Carefully pat dry the incision tapes after showering.

When to call your child’s surgeon

• Fever above 101oF that does not come down with Tylenol (mild fever is common)
• Difficulty breathing, with or without a croupy cough
• Active bleeding from the incision
• Redness, swelling, or persistent pain in the incision
• Vomiting

Follow-up:
A clinic appointment needs to be scheduled one to two weeks after the operation. Please call (602) 254-5561 to schedule this appointment.

Glossary:

• Steristrips – adhesive paper strips that are often placed over a surgical incision.  These usually peel off after 10-14 days.
• Fascia – a layer of tissue that in the abdomen provides strength and maintains intraabdominal organs (intestines, fat, etc.) within the abdominal cavity.  It is a weakness in this layer which causes a hernia
• Incarceration – the condition in which a piece of bowel or intra-abdominal fat gets stuck in the hernia defect. This may cause pain and could lead to a condition called strangulation in which the same piece of bowel or fat looses its blood supply and can lead to perforation and peritonitis, making the child very sick.