Ultrasonography of Inguinal Hernia
Open Inguinal Hernioplasty
Laparoscopic Inguinal Hernioplasty
Umbilical Hernia / Paraumbilical Hernia 臍小腸氣 / 臍旁小腸氣
1.1 About umbilical hernia / paraumbilical hernia
During the embryonic stage, the fetus relies on the umbilical cord to supply blood from the placenta. Blood vessels pass through the umbilical ring from the fetus into the umbilical cord. The umbilical ring typically closes automatically before the newborn baby is born. However, if the umbilical ring fails to close completely and the surrounding muscle structures of the umbilical cord are not fully developed, it can result in the protrusion of abdominal organs through a gap in the baby’s abdominal wall muscles, forming an umbilical hernia, commonly known as an “outie” belly button.
Even if the umbilical ring has closed at birth, the abdominal wall in this area remains weak. In adulthood, any condition that increases intra-abdominal pressure (such as pregnancy, abdominal fluid accumulation, etc.) can cause abdominal organs to protrude through an opening in the abdominal wall, forming a paraumbilical hernia.
1.2 Symptoms of umbilical / parumbilical hernia
Parents may notice a protrusion (hernia) at the location of their newborn baby’s belly button. The hernia is particularly noticeable when the baby is crying but tends to retract automatically when the baby is calm.
Paraumbilical hernia typically affects adults, and patients will notice a bulge near the belly button. Initially, the bulge may be only one to two centimeters and not very noticeable. However, over time, as the hernia continues to protrude, it can widen the opening in the abdominal wall, causing the hernia to become larger. The hernia becomes more prominent when the patient is standing or walking, and it automatically retracts into the abdominal cavity when lying down.
If the patient experiences persistent and severe pain, it may indicate that the organs (such as the small intestine) within the hernia sac are obstructed at the entrance, affecting their blood supply and potentially leading to tissue necrosis, known as a strangulated hernia. In such cases, emergency surgery is necessary. If you experience any of these symptoms, it is important to seek immediate medical attention. If the doctor diagnoses a strangulated hernia, urgent surgery is required.
1.3 Treatment of umbilical / paraumbilical hernia
Surgical treatment is currently recognized by the medical community as the only effective method to treat umbilical hernia.
In most infants, the umbilical ring gradually closes after birth, causing the umbilical hernia to naturally disappear before the age of one. However, if the umbilical hernia is still larger than 1.5 cm after the age of two, the doctor may recommend surgical treatment. The surgery is performed under general anesthesia. The doctor makes a semicircular incision at the location of the baby’s belly button and sutures the opening in the abdominal wall. After hemostasis, the incision is closed, and the surgery is completed.
For paraumbilical hernia, depending on the size of the hernia, it can be repaired using either traditional open hernioplasty or minimally invasive laparoscopic hernioplasty.
Conventional open hernioplasty
- The surgery is performed under general anesthesia. The doctor makes a semicircular incision at the belly button. The hernia sac is identified and removed, and depending on the situation, the abdominal wall opening may be sutured with sutures. Then, an artificial mesh is placed over the abdominal wall to prevent recurrence.
- The surgery is performed under general anesthesia. The surgeon makes a small incision of about one centimeter in the patient’s abdomen to access the abdominal cavity and performs laparoscopic surgery. A laparoscope, which is an instrument with a high-definition camera at the tip, is used to transmit images of the surgical area to a monitor, allowing the surgeon to observe the inside of the abdominal cavity and perform the surgery accordingly.
- The surgeon makes two 5-millimeter incisions in the abdomen and inserts minimally invasive instruments through the abdominal wall for the surgery. These instruments replace the surgeon’s hands, allowing for significantly smaller incisions.
- The surgeon uses the minimally invasive instruments to place a specially designed artificial mesh directly below the abdominal wall opening and fixes the mesh to the inner side of the abdominal wall using surgical staples. The purpose of the artificial mesh is to prevent organs from protruding through the abdominal wall opening.
- After hemostasis, the incisions are closed using absorbable sutures, and waterproof dressings are applied to protect the surgical wounds.
- This minimally invasive repair surgery is a relatively newer surgical approach. It significantly reduces postoperative pain for patients and effectively prevents hernia recurrence.
- The surgery usually takes a little over an hour.