Umbilical hernia repair

Umbilical Hernia Surgery in Puerto Vallarta

The navel is a naturally weak spot in the abdominal wall, and in an adult it can open up again over the years. Before any repair is proposed, three things are looked at: how big the defect is, how much it bothers you, and what may be raising the pressure inside your abdomen.

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Common symptoms and signs

An umbilical hernia is almost always noticed before it hurts. These are the findings that most often bring people in:

• A bulge at the navel, or just to one side of it, anywhere from the size of a pea to the size of a lime.
• The bulge stands out more when you stand up, cough, strain or lift something heavy.
• It shrinks or disappears when you lie down, and can usually be pushed back in with your fingers, without forcing it.
• Discomfort, burning or a pulling feeling around the navel at the end of the day or after exertion.
• A sense of pressure or heaviness around the navel, without clear pain.
• A change in the shape of the navel, which looks pushed out or stretched even at rest.
• No symptoms at all, which is common: the bulge turns up on a routine exam or on a scan done for something else.

When surgery is recommended

In an adult the umbilical ring does not close by itself: unlike in a baby, the tissue is no longer growing. Repair is recommended when the hernia hurts, when it has been getting bigger, when it limits everyday activity, or when it has become trapped at any point. If the defect is small and gives no trouble, it is reasonable to leave it alone and have it checked from time to time, as long as you know the warning signs; the risk of the bowel getting trapped is low, but it is not zero, and emergency surgery carries more risk than a planned operation. It is also worth knowing that, over the years, some of the people who choose to wait end up having surgery anyway because the hernia grows or starts to bother them — waiting is a decision you revisit, not a final answer. On technique, the 2020 joint guidelines of the European Hernia Society and the Americas Hernia Society recommend reinforcing defects larger than one centimeter (a little under half an inch) with mesh, and leave suture-only closure as an option to be decided with the patient in smaller defects. Before anything is scheduled, the conditions that raise pressure inside the abdomen are reviewed — body weight, a chronic cough, constipation, abdominal fluid from liver disease, a pregnancy still ahead — because they affect the result, and it is sometimes better to deal with them first.

How the repair is performed

The technique depends on the size of the defect, on whether this is a first repair or a repeat one, and on your own circumstances. It is planned surgery and, in most cases, you go home the same day.

1. You are examined standing and lying down, and the umbilical ring is measured. If the findings are unclear, if you have had abdominal surgery before, or if excess weight makes the exam difficult, an ultrasound or a CT scan is added.
2. Depending on the size of the hernia and the approach chosen, the operation can be done under general anesthesia, regional anesthesia, or local anesthesia with sedation. That is decided together with the anesthesiologist at the pre-operative visit, where the risks of the anesthesia itself and your medical history are also gone over.
3. Most small and medium defects are repaired through a short incision at the rim of the navel, which is what the guidelines recommend for the usual case. A laparoscopic approach, normally through three small ports, is considered when the defect is large, when the hernia has come back before, or when the risk of wound problems is higher.
4. Whatever has pushed through — most often fat, sometimes bowel — is returned to the abdomen and its condition is checked, and the gap in the wall is closed, taking care to keep the natural shape of the navel.
5. For defects larger than one centimeter, a mesh is placed so that it overlaps the edge in every direction, usually by two to three centimeters (roughly an inch), because at that size closure with sutures alone comes back more often. For smaller defects, mesh or sutures is a choice made with you, going through what each option offers and what it involves, including the drawbacks of mesh.

Go to an emergency room immediately if the bulge turns hard and will no longer go back in, if you get sudden severe pain at the navel, if the skin over it turns red or purple, or if it comes with nausea, vomiting, fever, or you stop passing gas and stool. That can mean a piece of bowel is trapped and losing its blood supply. Do not wait for an appointment, and do not try to force the bulge back in.

Recovery and risks

Most people go home the same day, after a few hours of observation, although some need to stay longer. For the first few days it hurts to cough, laugh or get out of bed, and that is managed with the pain medication you are given; walking the same day is part of the treatment, not something to put off. You are asked to avoid lifting and abdominal exercise for about four weeks — a general guide adjusted to your case, not a guaranteed deadline — and going back to work depends on how physical the job is, since a desk job resumes sooner than one that involves lifting. A lump or a firm area under the scar, from swelling and fluid, is common; it usually settles on its own, sometimes in weeks and sometimes over longer, and it is checked at your follow-up visits. Like any operation, this one carries risks: wound infection, a collection of fluid or blood, pain that lasts longer than expected, and the hernia coming back, which can happen even after a well-performed repair. On top of those are the risks of anesthesia and, less often, injury to the bowel, bladder, blood vessels or nerves, clots in the legs, and breathing or heart complications; when the operation is done laparoscopically, there is also the possibility of having to convert to open surgery partway through. This is not a complete list, and these risks do not weigh the same for everyone: the ones that apply to you, given your age and your health conditions, are gone over before you sign the consent form, along with the signs that should make you call.

Frequently asked questions

Can an umbilical hernia be fixed without surgery, with a binder or with exercise?

No. A binder can make the discomfort easier to live with and hold the bulge in, but it does not close the opening in the abdominal wall, and core exercises do not close it either. In an adult, surgical repair is the only treatment that corrects the defect. What does change the picture is controlling whatever raises the pressure inside the abdomen, such as body weight, a chronic cough or constipation.

It doesn't hurt. Is it dangerous to leave it alone?

Surgery is not always needed right away. For a small hernia that gives no trouble and pushes back in easily, watching it is a reasonable option. The risk of the bowel getting trapped in any given year is low, but published figures vary from one study to another, and none of them describes an individual case on its own, so you will not be handed a percentage in the office as though it were your personal prognosis. What is worth being clear about is that the risk does not go away with time, that some of the people who wait end up having surgery because the hernia grows or starts to hurt, and that an emergency repair is more complicated than a planned one. That is why, if you choose to wait, you should leave the consultation knowing exactly which signs mean going straight to an emergency room.

Is mesh always used?

No. When the defect is larger than one centimeter, international guidelines recommend mesh, because closure with sutures alone comes back more often. For smaller defects both options are valid and the decision is made in the consultation. Mesh is a reinforcing material that becomes part of the abdominal wall and, under normal circumstances, is neither removed nor needs any special care. It is not without drawbacks: it makes fluid collecting under the wound somewhat more common and, in uncommon cases, it can become infected or be linked to persistent pain, situations that may call for another operation to remove it. All of that is explained before you decide, once your own defect has been measured.

I'm visiting Puerto Vallarta. How long does the surgery take, and when could I fly home?

An uncomplicated umbilical hernia repair usually takes between half an hour and an hour, and in most cases you go home the same day. Light activity comes back within a few days, and usual activity, including exercise and lifting, at around four weeks. Visitors are operated on here regularly, but there is no standard date for flying, and you will not be given one before you have been examined. Two things set the timing: at least one follow-up visit after the operation, and those weeks of restricted lifting, which in practice includes handling luggage. If you already have a return flight booked, say so at the consultation so it can be taken into account when surgery is scheduled. These timeframes are a general reference, not a commitment: they change with the size of the defect, whether mesh was used, the kind of work you do and how healing goes, and a complication makes them longer.

My baby's navel sticks out. Will it need an operation?

Almost never. An umbilical hernia in a newborn or an infant is a different problem: in the great majority the ring finishes closing on its own, usually before the age of four or five. Taping a coin over it, binding it or strapping it does not help and can damage the skin. Surgery is considered if it is still there after that age, if the defect is large, or if at any point the bulge turns hard and painful and will not go back in — that last one needs to be seen the same day, at an emergency room. This is a pediatric surgeon's work, and at the consultation you will be pointed to where to go.

Do you take insurance? My policy was issued outside Mexico.

Patients with major medical expense insurance are seen. Bring your policy details to the consultation, because the paperwork and the insurer's answer depend on the particular contract and on how long the policy has been in force, and the medical report your insurer asks for is prepared at the office. If your policy was issued outside Mexico, check with your insurer first how it works here: many foreign plans reimburse you afterwards rather than paying the hospital directly, and some ask for authorization before the operation. What is covered is decided by your insurer, not by this office.

Consultation in Puerto Vallarta

The assessment takes one appointment: your abdomen is examined, the defect is measured, and the options are explained with their risks and their timelines — none of which commits you to surgery. The office is at De Los Tules 168-10, Jardines de Las Gaviotas, Puerto Vallarta. The consultation costs $800 MXN (Mexican pesos), patients are seen in English and Spanish, and patients with major medical expense insurance are received. If the bulge no longer goes back in, or the pain is severe, do not book an appointment: go to an emergency room.

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