Laparoscopic Umbilical Hernia Surgery: Procedure, Recovery

According to the classification by the European Hernia Society, an umbilical hernia ^[1] is defined as a hernia occurring between 3 cm above and 3 cm below the belly button. It occurs when part of the intestine or abdominal tissue protrudes through a weakened area near the belly button, forming a bulge.

This condition is more prevalent in women and those with elevated intra-abdominal pressure, such as during pregnancy, obesity or ascites. The stretching of the muscles in the abdomen and the presence of fatty tissue make it more likely for muscle bundles to separate. This increases the chances of developing umbilical hernias.

In rare instances, adults with umbilical hernias may get strangulated. It happens when blood flow to the herniated tissue is suddenly blocked. This risk is higher in non-reducible (incarcerated) hernias that cannot be pushed back into the abdominal cavity.

The modern approach to treating umbilical hernias is through laparoscopic surgery, a method replacing the traditional open procedure.

For an efficient and safe solution, laparoscopic umbilical hernia surgery with mesh fixation using absorbable sutures is recommended.

Anatomy and Physiology of Umbilicus

The umbilicus, or belly button, is situated in the centre of the abdomen. It is a remnant of the umbilical cord, which connects a developing baby to the mother's womb during pregnancy. 

An umbilical hernia results from the failure of the umbilical ring to close properly. The parts of the belly button consist of the following:

1. Nerve Endings: The umbilicus contains nerve endings, making it a sensitive area. Nerves in this area connect to the spinal cord, contributing to the sensation felt when touched.
2. Blood Vessels: They transport nutrients from the mother to the baby during pregnancy.

Laparoscopic umbilical hernia surgery may be recommended for various reasons to address this condition effectively. The indications are:

1. Pain and Discomfort: Persistent pain and discomfort around the hernia site that affects daily activities and quality of life.
2. Increasing Hernia Size: Noticeable enlargement of the hernia, indicating a need for surgical intervention to prevent further complications.
3. Incarceration of Hernia: The occurrence of incarceration where the hernia becomes trapped and cannot be gently pushed back requires surgery.
4. Risk of Strangulation: When a hernia becomes incarcerated, it possesses an increased risk of hernia strangulation. The blood supply is compromised in the nearby areas, necessitating prompt surgery.
5. Failed Non-Surgical Management: Ineffectiveness of non-surgical approaches, such as lifestyle modifications or trusses, in managing symptoms or preventing hernia progression.
6. Cosmetic Concerns: The appearance of a hernia is causing distress or affecting the self-esteem of a person.
   

Laparoscopic surgery offers the advantage of performing other intra-abdominal procedures simultaneously. It streamlines medical interventions and minimises the need for multiple surgeries. The benefits of treating umbilical hernia through laparoscopic surgery are:

1. Minimal Invasive: The surgery through laparoscope involves smaller incisions. It results in a more aesthetic outcome with minimal scarring.
2. Safe and Effective Technique: The procedure is considered safe and effective, even for individuals with multiple abdominal surgeries. 
3. Shorter Hospital Stay:  It allows for a shorter hospital stay than traditional open surgery. The patient is usually discharged within 2-3 days.
4. Quick Recovery: Laparoscopic surgery has a faster recovery than traditional methods. Return to work and daily activities more swiftly.
5. Less Pain and Swelling: The patient experiences reduced postoperative pain, swelling, and discomfort. It lowers the risk of complications, leading to a smoother recovery process.
   

Patients often have questions about what occurs before and on the day of the umbilical hernia surgery. The preparation before the surgery needs to be clarified.

Protocol Before Laparoscopic Umbilical Hernia Surgery

Prior to laparoscopic umbilical hernia surgery, the medical team follows a set of guidelines. It ensures the safety of the patient throughout the process.

On the Day of Laparoscopic Umbilical Hernia Surgery

On the day of laparoscopic umbilical hernia surgery, one can expect the following:

Laparoscopic hernia repair is a minimally invasive surgery performed by a general surgeon. The whole procedure takes about 30-45 minutes. The objective is to repair the hernia by returning the tissue to its proper place and closing the opening of the abdominal wall.

The step-by-step procedure is:

1. Patients were positioned supine with arms tucked alongside.
2. Monitors were placed on the right side of the bed to check the vitals.
3. Following general endotracheal anaesthesia, the abdominal skin was sterilized.
4. The surgeon creates two small incisions around the umbilical hernia.
5. A laparoscope, a thin tube with a camera, is inserted through one of the incisions.
6. The camera provides a view of the abdominal cavity on a video screen.
7. The surgeon carefully relocates the bulging tissue back through the abdominal wall hole.
8. The mesh was rolled and unrolled inside the abdomen against the abdominal wall to strengthen the area.
9. The incision sites are then closed using sutures.

Adults can generally expect 2 to 4 weeks to recover before resuming normal activities. Children can often return to most activities immediately following surgery.

Recovery in Hospital

Most patients are discharged on the same day for outpatient procedures. Larger hernia repairs may require a short hospital stay, typically not exceeding 2-3 days. The following are done after the surgery:

1. Vitals Monitoring: Patients are shifted to the recovery room for observation, where vital signs such as pulse, blood pressure, and breathing are closely monitored. 

2. Pain Management: Pain medication is prescribed as needed to manage discomfort.

3. Dietary Recommendation: Light food like soup is given after the surgery to improve healing.
   

At-home Recovery

Personalised recovery instructions are tailored to meet your needs after the discharge. At-home recovery after the procedure includes:

1. Hernia Compression Belt: After your surgery, the doctor suggests using a hernia compression belt, also known as a truss. It is a wide elastic belt that you wear around your abdomen to provide solid support to your stomach during the recovery period.
   It is recommended to wear the belt as often as possible, even while sleeping, for the initial six weeks post-surgery. If necessary, the doctor will guide you on the continued usage. This belt aids in minimizing fluid buildup above the mesh used in the repair process.
2. Initial Rest Period: Rest immediately after surgery, avoiding other plans on the surgery day. Gradually increase activity from the following day based on your comfort.
3. Pain Management Plan: Expect a prescription for pain medication post-surgery. Adhere to the medications as recommended for swift recovery.
4. No Fried Food: About a day after surgery, steer clear of fried foods. Opt for easy-to-digest foods like soup, sandwiches, pasta, potatoes, toast, and applesauce.
5. Avoid Strenuous Exercise: It is important to avoid more intense activities like running and weight lifting for at least six weeks post-hernia repair to ensure a smooth recovery.
   

First Follow-up

Follow-up appointments are scheduled after a week to monitor progress and address any concerns. The follow-up will be as follows:

1. Surgical Site Examination: The surgeon will inspect the incision site for signs of healing, ensuring proper closure and minimal scarring.
2. Symptom Review: Any postoperative symptoms or discomfort will be discussed. This will allow the surgeon to tailor the recovery plan accordingly.
3. Activity Guidance: Instructions regarding the gradual resumption of daily activities and exercise may be provided based on the healing progress.

Laparoscopic umbilical hernia surgery is generally associated with low risks. There can be some rare risks still involved. The risks associated with umbilical hernia repair surgery, including complications during the procedure and the broader risks related to anaesthesia and surgery, are:

Postoperative Complications

1. Wound Infection: Infection at the surgical site is a potential complication that requires careful postoperative management.

2. Bleeding: Excessive bleeding may occur if proper care is not taken during the procedure.

3. Haematoma: There is a risk of the formation of a haematoma. It is a collection of blood outside blood vessels.
   

Umbilical Hernia-Specific Risks

1. Intestinal Injury: Though rare, there is a small risk of injury to the small or large intestine during the hernia repair.

2. Hernia Recurrence: A 2% risk of hernia recurrence during extended follow-up has been found. Medical conditions like ascites and liver cirrhosis are primary factors that can increase the risk of recurrence. Therefore, controlling ascites is necessary before the surgery. 

Specific Organ Risks

1. Testicular Atrophy: Injury to gonadal vessels may lead to testicular atrophy, emphasizing the need for meticulous surgical care. It is a rare complication with 0.03-0.65% risk.
2. Fallopian Tube Damage: In girls, though rare (<1%), there is a possibility of damage to the fallopian tubes during surgery. It can have potential consequences for future fertility.

When to See a Doctor?

If a patient exhibits any alarming signs and symptoms after the surgery, promptly seek medical attention. Recognizing these indicators can help ensure timely intervention. These signs and symptoms can include:

1. Fever (101.5 degrees or higher)
2. Signs of Infection, such as redness, swelling, or pain
3. Any drainage from the incision site
4. Persistent pain that is not effectively managed with prescribed pain medicine
5. Bulge at the belly button

Timely medical intervention is needed to address umbilical hernias. Delaying laparoscopic repair may pose risks to one's health. These include:

1. Increased Size and Complexity: Delay may increase the size and complexity of the hernia, making the surgical repair more challenging. 
2. Chronic Pain and Discomfort: The hernia may cause persistent pain and discomfort, affecting the individual's quality of life and daily activities.
3. Difficulty in Routine Activity: Delayed repair may contribute to difficulty in performing daily tasks like unable to bend due to the pain in hernia.
4. Risk of Incarceration: There is a heightened risk of the hernia becoming incarcerated, where abdominal contents get trapped, potentially causing severe complications.
   
5. Increased Risk of Strangulation: There is an elevated risk of strangulation, where blood flow to the herniated tissue is completely cut off, resulting in tissue death.
   

The Laparoscopic Umbilical Hernia Repair cost in India can range from ₹ 1,10,000 to ₹ 2,00,000 with an average ₹ 1,40,000. Several factors influence the cost of the procedure, which includes:

1. Hospital Facility Costs: The overall cost of laparoscopic umbilical hernia surgery is influenced by the facility where the procedure occurs. Hospitals with advanced technology and high-quality infrastructure may charge more for their services.
2. Surgeon's Fee: The expertise and experience of the surgeon performing the laparoscopic hernia surgery can significantly impact the cost. Highly skilled and experienced surgeons may charge higher fees for their services.
3. Medical Supplies and Equipment: The use of specialised equipment and disposable supplies during the surgery can contribute to the overall cost. Laparoscopic procedures often involve advanced instruments, which may increase expenses.
4. Preoperative Tests and Consultations: Costs may include preoperative tests, such as blood tests and imaging studies, as well as consultations with the surgeon and other healthcare professionals before the surgery.
5. Postoperative Care: The recovery process also factors into the overall cost. This includes follow-up appointments, medications, and any additional care needed during the postoperative period.
6. Geographic Location: The cost of healthcare services can vary based on geographic location. Urban areas or regions with a higher cost of living may have higher overall expenses for medical procedures.
7. Health Insurance Coverage: The extent of health insurance coverage can significantly influence out-of-pocket expenses for the patient. Understanding insurance policies and deductibles is crucial in estimating the personal cost.
8. Complications and Unforeseen Circumstances: If complications arise during or after the surgery, additional medical interventions may be required, potentially increasing the overall cost. Unforeseen circumstances can contribute to unpredicted expenses.

Laparoscopic surgery is becoming popular for hernia treatment, particularly for recurrent hernias. It results in minimal scarring and swift recovery.

Schedule a free online consultation with HexaHealth for laparoscopic umbilical hernia surgery. You can discuss your condition, including the benefits and considerations of laparoscopic surgery, with one of our top healthcare providers.

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