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UMBILICAL HERNIAS
North Penn Hernia Institute



UMBILICAL Hernias as well as the nearby hernias called "Para-umbilical Hernias" develop in and around the area of the umbilicus (belly button or navel). A 'congenital' weakness (meaning 'present since birth') in the naval area exists. This was the area at which the blood vessels of the fetal and infant umbilical cord exited through the muscles of the abdominal wall. After birth, although the umbilical cord disappears (leaving just the dimpled belly-button scar), the weakness in the muscle wall underneath the navel may persist. Hernias can occur in this area of weakness at any time from birth through late adulthood. The signs and symptoms include pain at or near the navel area as well as the development of an associated bulge or navel deformity. This bulge pushes out upon the skin beneath or around the navel, distorting the normal contour and architecture in or around the navel (creating an 'OUTIE' instead of a normal 'INNIE').

Although often appearing at or just after birth, these hernias can also occur at any time during later life. In Infants, these hernias may gradually close by age 4 to 6 and surgery can often be delayed or even avoided entirely. Surgery is however required if these pediatric hernias are causing symptoms or are enlarging. This decision should be made after examination by a Pediatrician or skilled Surgeon. In Adults however, umbilical hernias cannot "heal", and do gradually increase in size and often become problematic. Incarceration or Strangulation may occur.

Optimally, these hernias should be repaired using a 'TENSION FREE REPAIR TECHNIQUE'. Umbilical hernias often occur in adulthood because of progressive and significant tension on the congenital area of weakness beneath the navel. This develops through the normal stresses and strains of daily activity. Standard techniques, still widely utilized today, attempt to repair these hernias by simply closing the muscle defect with sutures under significant tension. Often in these older method repair techniques, muscle layers are overlapped. Such suturing not only recreates the muscle layer tension that originally created the hernia defect, but too often also weakens adjacent tissue in the process. This only leads to unnecessary pulling of the tissues at the hernia area. We know that this tension on muscles inhibits normal healing, causes swelling, pain and prolonged recuperation. These older suture only techniques have been shown to be less effective than Tension Free mesh repairs.


THE RESULT OF HERNIAS REPAIRED WITH TENSION
Excessively prolonged recovery, and more importantly, a high risk of recurrence. This need not be the case any longer


At The NORTH PENN HERNIA INSTITUTE, our Surgical Staff is now fully trained to repair these hernias effectively in a TENSION FREE fashion, most often as a "One Day" procedure. This contemporary surgical technique is performed most frequently with mild sedation and local anesthesia, thus avoiding the risks of General Anesthesia. In Umbilical Hernias in adults, especially large and recurrent Umbilical Hernias, a Mesh is utilized to created a 'Tension Free' repair. The mesh is carefully opened "BELOW" (never on top) the defect, extending somewhat beyond the under edges of the hernia 'hole' itself. This immediately, safely and securely repairs the hernia. In addition, the mesh acts as a bridge or scaffolding for in growth of new tissue to broadly support the abdominal wall muscle as the mesh becomes incorporated into the muscle layer. No muscle is cut nor sewn together to create unnecessary or unwanted TENSION. This surgical mesh is extremely thin and very flexible, so it is undetectable to the patient in normal day to day activity. But it is strong enough to fully repair the hernia such that our patients are fully able to resume NORMAL ACTIVITY without undue concern for recurrence. Plastic Surgery skin closure technique is always utilized on Umbilical Hernias, as it is in all of our hernia incisions. The desired cosmetic concave appearance of the umbilicus or navel returns to normal after surgery and the navel is NOT removed nor altered.

Patients are discharged on the same day as surgery.

TYPICAL POST-OPERATIVE INSTRUCTIONS
for NPHI Patients


Return to NORMAL ACTIVITY in Days!!


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