HERNIA INSTITUTE OF PENNSYLVANIA
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UMBILICAL HERNIAS

UMBILICAL Hernias, and nearby hernias called "Paraumbilical Hernias" develop in and around the area of the umbilicus (belly button or navel). A congenital weakness (meaning present since birth) exists in the naval area in the region where vessels of the fetal and infant umbilical cord exited through the muscle of the abdominal wall. After birth, although the umbilical cord disappears (leaving just the dimpled belly-button scar), the weakness in the muscle may persist. Hernias can occur in this area of weakness at any time from birth through late adulthood. As the weakness progressively bulges and opens, abdominal contents are permitted to protrude through. In addition to the navel deformity and an associated bulge, the signs and symptoms include pain at or near the navel area. The hernia bulge pushes out upon the skin directly at or around the navel, distorting the normal contour and architecture, creating an 'OUTIE' instead of a normal 'INNIE' navel.

Although often appearing at or just after birth, these hernias can also occur at any time during later life. In INFANTS, these hernias most often gradually close by age 3 or 4, and surgery can often be delayed until that time. If however, these pediatric umbilical hernias are causing problems or enlarging, surgery can be recommended earlier. This decision for surgery should only be made after a comprehensive examination by a Pediatrician or skilled Surgeon.

In adults however, umbilical hernias cannot "heal" and gradually increase in size, often becoming progressively problematic as they enlarge. Incarceration or Strangulation may occur on the occasion of large and neglected Umbilical Hernias.
Optimally, umbilical 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 placing the muscle tissue under significant tension. Often in these older method repair techniques, muscle layers are overlapped creating even more tension. Such suturing not only recreates the muscle layer tension that originally created the hernia defect, but too often this process also weakens adjacent tissue layers as well. Moreover, this leads to unnecessary pulling of the tissues at the hernia area. We recognize surgically that any tension on sutured muscles inhibits normal healing and causes swelling, pain and prolonged recuperation. These older suture-only techniques have been shown to be significantly less effective than Tension Free mesh repairs with a much higher recurrent hernia rate later on.



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 usually performed 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 over) 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. In the process, the mesh safely becomes incorporated into the muscle layer. No muscle is cut, nor is it ever sutured together to create unnecessary or unwanted TENSION. The surgical mesh utilized for hernia repair is extremely thin and very flexible. Therefore it is undetectable to the patient both during normal day to day activity as well as during more aggressive physical and recreational activity. However, it is strong enough to fully and effectively repair the hernia such that our patients are fully able to resume NORMAL ACTIVITY without undue concern for recurrence. Plastic Surgery skin closure techniques are 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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215-368-1122
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