Periumbilical hernia
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A periumbilical hernia is a type of abdominal hernia that develops due to weakening of the abdominal wall within the linea alba, in the immediate vicinity of the navel. There is displacement of abdominal contents – most often a portion of the greater omentum or a loop of intestine – through a defect in the fascia. This condition can occur in both children and adults, but in adults it is usually acquired and is associated with increased intra-abdominal pressure and weakening of tissue structures. An untreated periumbilical hernia can lead to complications, including incarceration or strangulation of the intestine, and therefore requires appropriate diagnostic assessment and qualification for surgical treatment.
Periumbilical hernia – causes and risk factors
The pathogenesis of a periumbilical hernia is based on the coexistence of two elements: structural weakening of the abdominal wall and increased intra-abdominal pressure.
The most important risk factors include:
- obesity – chronic overload of the abdominal wall and disturbances in collagen metabolism,
- pregnancy (especially multiple) – stretching of the linea alba and separation of the rectus abdominis muscles (diastasis recti),
- ascites in the course of liver cirrhosis,
- chronic cough (e.g., COPD),
- chronic constipation and straining during defecation,
- physical work involving lifting,
- previous surgeries within the abdominal cavity.
Disorders of connective tissue quality also play a significant role, including abnormal synthesis of type I and III collagen. In some patients, there are genetic predispositions to hernia formation, which explains their occurrence even in the absence of obvious mechanical factors.
Periumbilical hernia – symptoms
Symptoms depend on the size of the defect and the contents of the hernia sac. Most commonly present are:
- a bulge in the umbilical area, enlarging with coughing, sneezing and exertion,
- a feeling of pressure or pulling around the navel,
- moderate pain, usually worsening toward the end of the day.
In the initial stage the hernia may be reducible – in the lying position the contents of the sac return to the abdominal cavity. As the disease progresses the change may become fixed.
Alarm symptoms suggesting incarceration or strangulation include:
- sudden, severe abdominal pain,
- a painful, hard bulge that cannot be reduced,
- nausea, vomiting, inability to pass gas or stool,
- signs of intestinal obstruction.
This condition requires urgent surgical intervention because of the risk of intestinal ischemia and necrosis.
Periumbilical hernia – diagnosis
Diagnosis in most cases is based on clinical examination. The surgeon detects the presence of a defect in the fascia and a palpable hernial orifice.
Imaging studies are used in doubtful situations or before planned surgical treatment:
- abdominal wall ultrasound – allows assessment of the size of the defect and the contents of the hernial sac,
- computed tomography (CT) – recommended in cases of large hernias, obesity or suspected complications,
- magnetic resonance imaging (MRI) in selected cases.
The classification of primary abdominal wall hernias according to the European Hernia Society (EHS) takes into account the location (including the umbilical region) and the size of the defect:
- small (<2 cm),
- medium (2–4 cm),
- large (>4 cm).
This classification is important when planning the surgical technique and assessing the risk of recurrence.
Periumbilical hernia – treatment
In adults there is no effective conservative treatment that would lead to permanent closure of the defect. Hernia belts can only temporarily reduce symptoms, but do not eliminate the cause of the disease.
The standard approach is surgical treatment. The choice of method depends on:
- the size of the hernia,
- the presence of obesity,
- the presence of diastasis of the rectus abdominis muscles,
- coexisting diseases (comorbidities).
In small hernias (<1–2 cm) it is possible to suture the defect using the patient’s own tissues (herniorrhaphy). However, in adults reinforcement of the abdominal wall with a synthetic mesh is preferred, because this significantly reduces the recurrence rate.
Preparation for the procedure includes:
- weight reduction in patients with obesity,
- optimization of diabetes control,
- cessation of tobacco smoking,
- treatment of chronic cough.
A rational approach to modifying risk factors reduces the frequency of postoperative complications and improves treatment outcomes.
Periumbilical hernia – surgery
The aim of the operation is to reduce the contents of the hernia sac and permanently close the hernia defect.
Techniques used:
1. Open method
- skin incision in the umbilical area,
- dissection of the hernia sac,
- closure of the defect using a mesh (onlay, sublay techniques).
2. Laparoscopic method
- introduction of instruments through trocars,
- placement of an intraperitoneal mesh (IPOM),
- less tissue damage and potentially faster recovery.
Anesthesia may be general or regional, depending on the extent of the procedure. In uncomplicated cases the operation is performed electively, often as day surgery.
Possible complications include:
- hematoma or seroma,
- wound infection,
- chronic postoperative pain,
- hernia recurrence (more common when mesh is not used).
Return to full physical activity is usually recommended after 4–6 weeks. The prognosis after a properly performed operation is very good, and the risk of serious complications is significantly lower than with an untreated hernia.
