Umbilical hernia – in children

What is an umbilical hernia?

During pregnancy, the umbilical cord passes through an opening in the abdominal wall. This opening should close soon after birth, but in some cases the muscle does not close completely. An umbilical hernia occurs when bowel (intestine) or fat tissue pushes through a weakness in the muscles of the abdominal wall resulting in a swelling in the belly button area. There is no way of preventing an umbilical hernia; it is not due to anything a mother did in pregnancy.

Umbilical hernias usually close on their own without any intervention or treatment; many of them disappear spontaneously within the first year of life and most of them close by the age of three years. If it has not closed on its own by the time the child is aged three years then an operation might be undertaken.

Why treat an umbilical hernia?

It is not essential to treat an umbilical hernia. The risk of bowel/ fat tissue becoming trapped in the umbilical hernia (called ‘strangulation’) is remote so, the main reason for surgically repairing the hernia is because the child is unhappy with the appearance of his / her belly button. Even after surgery the belly button may remain prominent so have the appearance of an ‘out-ee’ belly button. It is therefore important that your child understands that everyone’s belly button is individual so everyone’s looks a bit different. In girls, the umbilical hernia may be repaired in order to prevent any complications in later life during her own pregnancy (such as part of the pregnant womb pushing through the hernia).

The operation

The operation to correct the umbilical hernia is carried out under general anaesthetic. The surgeon will make a small cut in the belly button (umbilicus) and close the muscle defect. The wound is stitched on the inside of the skin so you will not be able to see any of the stitches. All stitches are dissolvable. Sometimes paper tapes (called ‘steristrips’) are also applied. Sometimes a dressing will be applied over the steri-strips.

Local anaesthetic will be used at the end of the operation to minimise discomfort when your child wakes up.

Before admission to hospital

Purchasing suitable painkillers:

It is important that you purchase some children’s pain killers such as paracetamol (for example Calpol) and ibuprofen before admission to hospital so that you have these available at home after discharge.

If your child becomes unwell

If your child has a cold, cough or illness such as chicken pox the operation will need to be postponed to avoid complications. Please telephone us (the telephone number is provided at the end of this leaflet) to discuss, prior to coming to hospital.

Starvation times

Your child will not be able to eat and drink before the operation. Specific advice about this will be included in your admission booking letter.

After the operation

• Once fully awake your child will be able to have a drink and something to eat. Painkillers will be given as needed, usually paracetamol and / or ibuprofen.
• Unless your child has an underlying condition, which necessitates monitoring after an anaesthetic, children who have had an umbilical hernia repair can go home on the same day as the operation.
• If your child needs to stay in hospital overnight, we will provide a bed for a parent /
  carer to also stay if required.

After the operation there may be some swelling that is evident. The swelling may take a few weeks to completely disappear.

What are the complications of an umbilical herniotomy?

Complications from this operation are uncommon. Rare complications include:

• infection
• recurrence of the umbilical hernia bleeding

In many cases there is little cosmetic change to see immediately after the operation. As swelling settles and your child grows the cosmetic appearance will change but many children continue to have a belly button with skin that protrudes after undergoing umbilical hernia repair; surgery does not therefore guarantee that the belly button will have the appearance of being flat and / or what may be described as an ‘inny’ belly button.

Discharge advice

• Your child’s wound should be kept clean and dry; avoid baths for five days after the operation.
• Wiping over the area with warm water is fine.
• We advise that your child wears loose fitting clothes for a few days after the operation. Denim trousers, for example, can rub on the wound and make it sore.
• Children may find some physical activities uncomfortable such as PE at school, bicycle riding and swimming. They should therefore avoid these for one to two weeks.
• Paracetamol (‘Calpol’) and / or ibuprofen (‘Brufen’ or ‘Junifen’) should be given to prevent pain. Please follow the instructions on the bottle.
• Steri-strips can be removed by gently peeling them off whilst your child is in the bath five days after the operation. If the steri-strips fall off before this time it is not necessary for them to be replaced.
• If your child has a dressing after their operation, gently remove it after 48 hours. If the dressing falls off before this time it does not need to be replaced.
• Occasionally a wound can become infected. If your child’s wound becomes red or there is increased tenderness, contact your GP.

Chaperoning

During your child’s hospital visits she / he will need to be examined to help diagnose and to plan care. Examination, which may take place before, during and after treatment, is performed by trained members of staff and will always be explained to you beforehand. A chaperone is a separate member of staff who is present during the examination. The role of the chaperone is to provide practical assistance with the examination and to provide support to the child, family member / carer and to the person examining.

Follow up

Follow up in a surgical outpatient clinic is usually not required. If there are concerns please contact your family doctor (GP) or the nurse specialist team (number below).

For further information / queries please contact:

The ward you were on…………………………………………………………..

Your nurse specialist……01223 586973………………………..