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The abdominal wall is a strong muscle and connective tissue structure that wraps the abdominal organs like an envelope and gives our body its shape. This envelope has some potential weak points. Intra-abdominal organs (especially adipose tissue and intestines) pass through the abdominal wall through these weak points and cause swelling under the skin. It is also called hernia. Abdominal wall hernias are treated surgically by General Surgery specialists.
There are some potential weak spots in the abdominal wall, both congenital and later. One of them is the navel, which is the place where the veins that provide the baby's nutrition from the mother enter the baby's body while in the mother's womb. After the baby's umbilical cord falls off, a hard scar tissue forms in this area that creates the usual appearance of the navel, but the area's potential weakness remains, and some people may develop an opening in the abdominal wall in this area later in life. In infants, this opening mostly closes spontaneously within the first four years of age. If it does not close or if it occurs at a later age/adult life, it should be treated with surgery. _cc781905-5cde-3194-bb3b-136bad5cf58dc_cc583195d
Severe and sudden or chronic strains that may occur in the abdomen may cause the development of an umbilical hernia. Situations that increase intra-abdominal pressure create these strains. Conditions such as carrying heavy loads for a long time, constipation requiring constant straining, and prolonged coughing increase intra-abdominal pressure.
There are many difficulties that an umbilical hernia brings to one's personal life. Its symptoms vary. While small hernias are manifested by pain, as the hernia grows, it causes a swelling under the skin, causing a physical appearance disorder and restriction in daily movements. This situation prevents the person from moving freely in society and damages his self-confidence. Since hernia is a growing and progressive disease unless treated, it should be treated as soon as possible after detection.
Avoiding more serious medical problems also makes it necessary to treat an umbilical hernia. As described, umbilical hernia occurs when intra-abdominal organs pass through the opening in the navel and form a swelling under the skin. Often, organs constantly enter and exit through these openings. From time to time, due to the high intra-abdominal pressure, a large volume of organs passes through the abdominal wall and settles under the skin, but due to the large volume, it cannot return to the abdomen. This condition is called compression of the hernia (incarceration) and can lead to intestinal obstruction. If this process is prolonged, the blood vessels feeding the organs will be under pressure and can cause decay, a condition called strangulation of the hernia. Both conditions should be treated surgically under emergency conditions. Since surgery in emergency conditions may involve unpredictable risks for both the patient and the physician, surgical treatment should be performed as soon as possible by providing ideal conditions when a hernia is detected. This is much more comfortable for both the patient and the physician.
The principle of treatment in abdominal wall hernias is basically the same as repairing a hole in a wall. It is clear, therefore, that a mechanical problem must have a mechanical solution. In today's conditions, there are no drugs or methods (exercise, etc.) to close the openings in the abdominal wall by creating new and solid tissues. Until a better one is developed, surgery will be the only option in the treatment of abdominal wall hernias.
In the treatment of umbilical hernia, the opening in the navel is repaired without tension with either stitches or a patch. With the development of new technology materials, the use of synthetic materials has become very common today. Synthetic patches are advantageous for tension-free repair. When the patch is placed on the body, it is perceived by the body as a foreign body and a hard tissue forms around it. This hard tissue provides a solid and durable closure of the hole in the hernia area.
Hernia operations can be performed with open or closed (laparoscopic) methods.
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In open surgery, the opening in the navel area is revealed with an approximate incision made in the navel area, and it is closed without tension with sutures or a synthetic patch spread over it.
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In the laparoscopic method, the camera and special instruments are entered through 3 small incisions made on the left side of the abdomen, and the opening in the navel is seen from the inside. The patch that will close this opening is placed and attached to the abdominal wall with a screw-like technique and repaired.
There is no difference between the two methods in terms of success, but since the incisions made in laparoscopic surgeries are smaller, postoperative pain is significantly less. In open surgeries, if the opening is too small, it can only be repaired with stitches. In this case, open repair may be preferred in small umbilical hernias, since the incision will be very small. There is an obligation to use synthetic patches in laparoscopic surgeries. Considering the need to enlarge the incision in order to put a patch in large umbilical hernias, the laparoscopic method, which allows the problem to be solved through very small incisions, provides significant comfort for both the patient and the physician. In large umbilical hernias, the laparoscopic method reduces post-operative pain. The laparoscopic method should be preferred because of the comfort it provides to the patient in the postoperative period.
In the vast majority of hernia surgeries (assuming no problem occurs), the hospital stay is short. The hospital stay for umbilical hernias is one night. After the patient returns home, he is invited to the hospital for a control examination on the seventh day of his surgery, and the patient does not have to come to the hospital for a check-up, mostly, the doctor is consulted if there is any complaint.
Since the repair is made in the umbilical region, the surgical area will be weak at the beginning, so heavy exercise and strain should be avoided until the wound healing process here reaches a certain stage. Patients can return to their daily lives 48 hours after the surgery. The patient should rest between 3 and 7 days, depending on the weight of the job and the pain condition. The vast majority can return to work (not requiring heavy physical activity) within 4-5 days. Lifting more than 5 kg or heavy sports for six months is not recommended for those who do not do active sports. Active athletes can start routine training after 6 weeks.
The most important problem that may occur during or in the early postoperative period is bleeding in the operation area. Rarely, second surgeries may be required to control bleeding.