I want to tell you about a situation that we encounter very often in the journal of a pediatric surgeon: umbilical hernia.
We come across such strange situations… Tearful mothers who think they will lose their babies because of the swelling in the umbilical area, those who insist on attaching a metal coin to the umbilical hernia, and those who bring their very young babies for urgent umbilical hernia surgery…
I wanted to briefly explain this umbilical hernia from a pediatric surgeon’s perspective.
Normally, there is a tough white layer on top of the muscles in our abdominal wall, called the fascia layer. In the area where the umbilical cord passes through, there is a ring that allows the cord to pass through. When the baby is still in the mother’s uterus, this ring is open for the permeability of the vessels in the umbilical cord. But after birth, the layers of the abdominal wall slowly begin to close this ring, resulting in a closed, fibrous area. This closure process can continue until the age of five in most children. Note that I did not say all children, but most children close it before the age of five.
There are some situations where we believe that the umbilical ring cannot close on its own or will not close. For example, if the diameter of the fascia ring we feel during the examination with our finger is greater than 1.5 cm, which I repeat is not the swelling you see on the outside, self-closure is not very likely. Also, in some soft tissue diseases such as Down syndrome, hypothyroidism, and in children with increased intra-abdominal pressure, peritoneal dialysis or ascites, we do not expect self-closure.
Umbilical hernias often do not cause any complaints other than what is seen on the surface. We rarely see situations like hernia incarceration or bursting of the swelling, as we saw in previous cases of inguinal hernias. Only a bubble protruding from the umbilical area when the baby cries or strains can be a bit annoying to see. But since most of them close on their own, they do not cause any problems. However, we should not confuse them with pathologies called epigastric hernias located above the belly button in the midline, as epigastric or supragastric hernias do not close on their own.
So when and why do we perform surgery for umbilical hernias?
We perform surgery only in very rare cases where strangulation occurs in umbilical hernias, where the soft swelling that normally easily goes inside hardens and does not return to the abdominal cavity, where there is a giant umbilical hernia like in the photo,
and there is no reduction in size within the first two years, if the child has reached the age of four but the umbilical hernia is still the same size and is accompanied by conditions that prevent the closure of the umbilical ring, and if the child is overly concerned or teased by their peers.
Let me repeat again, we do not take actions like sticking metal coins on the navel. It can harm the child’s skin for no reason and cause the protruding contents to get trapped and damaged under the metal.
What is the surgical process for umbilical hernia?
It is very simple. There is no need for hospitalization. You come to the hospital for your surgery appointment, have your operation, and go home the same day. There are no procedures like dressing changes or stitch removal after surgery. You only come for a check-up after 4-5 days, and that’s it.
Of course, the ease of the process does not mean that we have to operate on every umbilical hernia. Surgery is only necessary if the conditions I mentioned earlier are present.
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Stay happy.
Prof. Dr. Egemen Eroğlu
April 2023