Umbilical (naval) peri- & supra-umbilical, and epigastric hernias

Umbilical hernias (navel), peri- & supra-umbilical, and epigastric hernias

All of these occur exactly down the middle – midline – of the abdominal wall.

I call them primary (first time, no previous surgery) midline abdominal hernias.

These can all be considered under one heading when discussing why they occur and how to repair them.

Umbilical hernias (navel)-occur actually in the middle of the navel. The inside of the navel sticks out – an ’outie’.

Para-umbilical, peri-umbilical and supra-umbilical hernias – occur next to or just above the navel / umbilicus. (para- or -peri mean near to or next to, supra- means above)

Epigastric hernias – occur a little bit higher – in a part of the abdominal wall called the epigastrium. This lies between the navel (umbilicus – see 2 in the picture) and the rib cage. So you can see all of these overlap a bit.

All of them ALWAYS occur in the midline – that is, straight down the middle, because they come out between the two rectus (‘6 pack’) muscles, anywhere from the navel up to the rib-cage. There is no muscle here – just a strip of tendon-like tissue running between the two muscles.

(The lump may sometimes seem to be off to on side, but the actual hole is always in the midline).

The strip of tendon, usually no more than a centimetre wide is known as the ‘linea alba’ or white line. A hernia forms if a split occurs in this tendinous strip – like a button-hole. And something pops out through the split (see 1).

What would I see?

A bulge or lump beneath the skin. It can vary in size from the size of a small grape to a large grapefruit. It depends how big the hole becomes and how much pushes out.

What is the lump?

It is usually fat that lies beneath the muscle. Part of our natural padding. Sometimes though it may be intestine, and if that gets trapped then you have a problem.

Repair?

Yes – you should. These hernias can be relatively painless but if left alone they always enlarge, and like all hernias, if left alone they:

run the risk of strangulatin
are more difficult to fix.

Best repair?

Using (some type of non-absorbable) mesh gives the best, most secure repair, BUT has to be done properly.

The mesh should be placed BENEATH the split or hole. Putting it on top can lead to all sorts of problems such as fluid accumulatipn and chronic infection.

Open or Laparoscopic?

Both work well. Laparoscopic repair has two problems –

you are making 3 holes to fix one. Only worthwhile if the hernia is fairly large, because each of the holes has the potential to become a hernia – see port-site hernias.
the mesh is put inside the abdomen – and can cause problems if the intestine sticks to it

Bottom line. …

Have your mid-line abdominal hernia repaired – and as always, choose a good surgeon!