Hongkong Hernia Centre

Paraumbilical Hernia

Introduction What symptoms and signs do paraumbilical hernias cause? Do paraumbilical hernias need surgery? What are the surgical options? How long does it take to recover after a paraumbilical hernia repair? References


Introduction top

Paraumbilical hernias occur in all age groups and must be distinguished from umbilical hernias as they do not resolve spontaneously.    Paraumbilical hernias are more common after the age of 35 years and are five times more common in women than men.   These hernias arise because of weaknesses which develop in fibrous tissue above and below the umbilicus in the midline and in the fibrous tissue around the umbilicus.  The commonest site is in the midline just above the umbilicus.

What symptoms and signs do paraumbilical hernias cause? top

There may be a swelling just above the fold of the umbilicus which is more noticeable when the patient coughs or strains.  Pain (possibly caused by dragging on the fat and peritoneum of the supporting ligament on the inside of the abdominal cavity in the midline) may also be present.  They are often tender to touch.  If the hernia is small, the diagnosis is aided as the patient stands erect and your specialist palpating the midline to the umbilicus.  The paraumbilical hernia may be felt as a small palpable nodule, just above or below the umbilicus.  Localised severe pain, redness, tenderness and general poor well being may indicate strangulation or inflammation.

Do paraumbilical hernias need surgery? top

Yes: as the incidence of complications, such as incarceration, inflammation and necrosis, is much higher than for true umbilical hernias.

What are the surgical options? top

They can be easily dealt with by open surgery through a small incision, above or below the umbilicus.  The defect is best repaired using a tension free mesh technique placed in the preperitoneal plane so that the mesh does not stick to the intestines.  A recent study has shown that the mesh repair is superior in terms of reducing the recurrence rate and where the minor complications were similar in both mesh and sutured groups15.  Although this study was carried out for umbilical hernias, the principle is the same.

How long does it take to recover after a paraumbilical hernia repair? top

You can have this repaired as a day case or as an overnight stay.  Recovery is usually about 7 days for most patients.  Your ability to drive a car is governed by being able to put your right foot on the brake pedal to perform an emergency stop without inhibition (automatic transmissions) or both feet on the clutch and brake pedals (manual transmissions).  Avoidance of heavy lifting or straining for three months is recommended to allow the tissues to reach their maximal tensile strength and therefore reduce the risk of recurrence.