What is an umbilical hernia?
An umbilical hernia is the protrusion of intra-abdominal contents through the umbilical opening — a natural weak point in the abdominal wall where the umbilical cord was attached during fetal life. It appears as a soft swelling at or just above the navel.
It is distinguished from paraumbilical hernia (just above or below the umbilicus). In adults, it usually develops gradually and never resolves spontaneously. Definitive treatment is surgical, especially when symptomatic or large in size.
How common is it?
Umbilical hernias affect approximately 2% of the adult population, with similar frequency in men and women. In children they are very common (up to 20% of newborns), but the majority close spontaneously by age 4–5.
In adults, peak incidence is between 40 and 60 years, with significantly increased risk in obesity, pregnancy and chronic raised intra-abdominal pressure.
How does it present?
The main symptoms of umbilical hernia include:
- Visible swelling at the umbilicus, more pronounced on standing or straining.
- Local discomfort or mild pain, particularly with effort.
- Feeling of heaviness in the abdomen.
- In larger hernias: skin changes overlying the swelling.
- Reducibility (the swelling disappears when lying down).
- Severe pain, redness, fixation of the swelling, vomiting — incarceration or strangulation, requires emergency surgery.
How is it diagnosed?
Diagnosis is primarily clinical:
- Clinical examination in supine and standing positions, with and without Valsalva.
- Measurement of the size of the defect and evaluation of reducibility.
- Ultrasound of the abdominal wall in unclear cases or for evaluation of defect size.
- CT in larger or complex hernias for preoperative planning.
- Evaluation of the entire abdominal wall for additional defects (paraumbilical, epigastric).
Which factors increase risk?
There is a familial predisposition to umbilical hernias, with disorders of collagen synthesis playing a role. Acquired risk factors are however predominant.
- Family history of hernia.
- Obesity (the strongest risk factor in adults).
- Pregnancy, particularly multiple pregnancies.
- Chronic cough, chronic constipation, prostatic hypertrophy.
- Ascites (cirrhosis, heart failure).
- Heavy lifting, weightlifting.
- Connective tissue disorders.
- Previous abdominal operations near the umbilicus.
Modern therapeutic options
The choice of the appropriate technique is individualised for each patient, based on hernia size, abdominal wall quality, comorbidities and patient preference.
Open Repair with Mesh
The most common technique for small to medium umbilical hernias (up to 3–4cm). A small incision at the umbilicus, anatomic reduction and placement of a biocompatible mesh in the preperitoneal (sublay) position. Excellent long-term results with a low recurrence rate.
Laparoscopic Repair (IPOM-Plus)
For larger hernias (>3cm), in obese patients or recurrent hernias. Through 3 small incisions, with primary closure of the defect and placement of a dual-sided intraperitoneal mesh (IPOM-Plus). Preserves the umbilicus, with less pain and faster return.
Robotic Repair (rTAPP / r-TARUP)
For complex, recurrent or larger umbilical hernias, often with concurrent rectus diastasis. The robotic system places the mesh outside the peritoneal cavity — in a preperitoneal or retromuscular plane — with primary closure of the defect, avoiding the intraperitoneal adhesions of IPOM.
Frequently asked questions
Is an umbilical hernia serious?
On its own, a small umbilical hernia often poses no immediate danger. However, there is always a risk of incarceration or strangulation (which is an emergency), and it typically enlarges gradually. The recommendation is elective surgical repair when diagnosed in adults.
Can I avoid the mesh?
In very small umbilical hernias (<1cm) repair with simple suture is possible. However, with mesh the recurrence rate falls from approximately 30% to below 5%. The decision is made individually after evaluation.
Can the hernia recur?
With modern techniques using mesh, the recurrence rate is 2–5%. Recurrence risk is increased by obesity, smoking, diabetes mellitus and very large hernias.
Will the umbilicus look natural after surgery?
Yes. The cosmetic result is usually excellent, with the umbilical incision well hidden inside the natural folds of the umbilicus. In very large hernias with skin distortion, additional umbilicoplasty may be required.
How quickly can I return to exercise?
Light activity (walking) from the next day. Office work in 7–10 days. Exercise and strenuous activity after 4–6 weeks. With laparoscopic technique, return is somewhat faster.