Robotic Umbilical Hernia Repair

What is an Umbilical Hernia?

Umbilical Hernia

A hernia is a bulge that has formed when the internal organs of the body push through a weak spot in the abdominal wall.

Umbilical (paraumbilical) hernia is the bulge that forms near the navel or belly button, when a part of the intestine, fat or fluid is pushed out through a weakened muscle of the abdomen. Umbilical hernia can be found in both children and adults.

In children:

It is common in infants and young children, especially in premature babies. The umbilical cord passes through a small muscular opening in the baby’s abdomen during pregnancy. Sometimes the muscles of the umbilical opening fail to close completely after birth. This leads to a weak spot near the navel which allows internal organs of the abdomen to push through it.

In adults:

People with various health issues that can cause pressure on the abdomen, such as being overweight, multiple pregnancies, having ascites (excessive fluid in the belly), are prone to developing an umbilical hernia. Other situations such as lifting heavy objects, strain on the abdominal muscles during constipation or coughing, and a large prostate gland may cause an umbilical hernia.

What are the signs & symptoms?

The main symptom of an umbilical hernia is the presence of a swelling or bulge near the navel which ranges from about 1 to 5 cm in diameter.

The bulge may be noticeable in babies when they cough, cry or strain the abdomen, and may reduce while lying down or staying calm. This hernia is generally not painful in children. However, umbilical hernias in adults may cause pain, discomfort and increase in size over time.

Umbilical hernias have the risk of getting trapped and strangulated, thereby cutting off the blood supply to the trapped part. This may cause death of the trapped tissue (necrosis) and result in severe complications. If you or your baby experiences the following symptoms, you should immediately consult your doctor:

  • Tender, painful, swollen or discolored bulge
  • Vomiting
  • Fever
  • Severe abdominal pain

What are the methods of screening & diagnosis?

To diagnose an umbilical hernia your doctor will enquire about your symptoms and your medical history.

Physical examination is generally conducted for determining the size and prominence of the umbilical hernia. Your bulge will be examined when you are standing and lying down. Your doctor may try to reduce the bulge by pushing it inside your abdomen, and will ask you to cough to see if there is any change in the size of the bulge.

Your doctor may also order blood tests and imaging tests to confirm the diagnosis:

  • Imaging tests such as X-rays, magnetic resonance imaging (MRI) or computer tomography (CT) scan may be ordered to determine the part of the internal organ that is protruding into the bulge.
  • Blood tests may be ordered to confirm a strangulated hernia by checking the white blood cell and red blood cell count. Infection, inflammation, tissue death or bleeding can be detected with blood tests.

What are the treatment options?

In adults, a painful and enlarged bulge is usually treated with surgery. Surgery can prevent further complications of the hernia which can occur due to strangulation.

However, in children, the hernia generally resolves by 18 months. Your doctor may wait for a while before suggesting surgery. Indications for recommending surgical repair in children include:

  • Painful, trapped or strangulated hernia
  • Hernia fails to close by 5 or 6 years
  • Large hole near the navel (greater than 1 inch in diameter)

Your surgeon may perform robotic-assisted keyhole surgery (laparoscopy) for repairing the umbilical hernia. Thismay be recommended if the hernia has reappeared after a prior surgery. Surgery can be performed under general or local anesthesia. However, local anesthesia is given to adults with small hernias and in whom general anesthesia may not be safe.

Mesh Patch

Laparoscope

Robotic-assisted laparoscopic surgery: The robotic system consists of a surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance vision system (3D camera) and miniaturized surgical instruments. While performing the surgical procedure, your surgeon will be seated at the console.

Your surgeon will make two to three small incisions away from the bulge and insert a laparoscope (a fiber-optic tube with a light source and camera attached to it) and other special miniaturized instruments through the incisions. The robotic arms hold the laparoscope and these instruments in place. These instruments help your surgeon perform the procedure with precision and control. Every move that your surgeon makes is immediately translated by the movement of the robotic arms. The bulge will be pushed into the abdominal cavity, and the abdominal wall will either be stitched or a mesh will be placed to support the weak part of your abdominal wall.