Surgical Procedures
Umbilical/ventral hernia
What is a hernia?
A hernia is a bulge of tissue created by a tear or weakness in the muscles of the abdominal wall that may allow the intestines to push through during movement, coughing, or lifting. Potentially, the intestines could and sometimes do become trapped in the hernia sac, causing an incarcerated hernia. The intestines may also become twisted in the hernia sac, causing a strangulated hernia. Both of these are painful, and can lead to more complicated operations and/or an emergency operation.
A hernia in the belly button area is called an umbilical hernia. This kind of hernia is common in individuals who are overweight or in women who have had more than one pregnancy. The tissue at the umbilical area is naturally weak because of a small opening in the fascia left over from birth. As people age, it can actually form a gap, which by definition is the hernia.
A ventral hernia may be in the location of a previous incision, where the scar underneath the skin has weakened, or it may be in another location of the abdominal wall.
How do I know if I have a hernia?
Usually a hernia causes pain with lifting, moving, or coughing; Dr. Beutel will make the appropriate diagnosis. A developed hernia has a bulge of tissue that protrudes upon coughing or stressing the abdominal muscles. Umbilical hernias can vary in size from a coin to a softball. The bulge will often disappear on its own when the person lies back, or it can be pushed back in place. With a very early weakness sometimes there is no bulge, but just pain. Also, there can be a bulge with very little localized pain. With a strangulated hernia there may form a hard bulge that won’t go down and there may be symptoms of pain, nausea, and vomiting. This situation must be handled as an emergency.
Usually the best diagnosis comes through taking a careful history and a thorough physical exam. Also, Dr. Beutel may order some tests, such as a C-T scan, to make sure that your organs and intestines are functioning properly.
I have a hernia. What happens next?
The best treatment for a hernia is an operation to repair the strained or torn muscle in the abdominal wall. This eliminates the possibility of a strangulated or incarcerated hernia, and usually the pain goes away.
Ventral hernias were previously repaired open, with a larger incision, but now laparoscopic repair has increasingly proven to be a good alternative. Laparoscopic repair is done through several tiny incisions, and a camera is used to see inside the abdomen. Some laparoscopic cases are outpatient procedures in which the patient can return home the same day.
For an umbilical hernia, the open approach is the safest and most efficient alternative.
For hernia surgery, the patient remains asleep for the entire procedure. This kind of repair usually takes around one to two hours, sometimes a little longer.
What are the risks of the operation?
Reoccurrence of a hernia can occur in 5 to 50% of cases. Newer methods of repair are designed to help minimize reoccurrence. Being overweight increases the risk of reoccurrence, as does gaining weight after the repair. Losing weight (if overweight) helps reduce the risk of reoccurrence. Other risks include bleeding, infection, perforation of the bowel, and fistula drainage post-operatively. These complications could require additional operations.
What do I need to do to prepare for the surgery?
You will be given separate instructions at the office checkout and from the hospital. Be sure to follow these carefully. If you smoke, it would be best if you could stop or reduce the amount drastically. It will help your lungs during the surgery, and coughing less will diminish the stress on the sutures afterwards.
Related documents: 
Umbilical/ventral hernia post-operative instructions
