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Is Having A Small Sized Umbilical Hernia A Cause For Concern?
Question: Hi,
I contacted you March 29th about having both an umbilical rash and hernia. I saw a surgeon and wanted to ask you some more questions. He described the hernia as extremely small (4 to 5 millimeters). He said he didn't think I needed surgery but he would do it if I wanted it. I've read some information since my apt about hernia strangulation that scares me and I'm still thinking of doing the surgery.
A) I thought from everything I read that the smaller hernias were less likely to need surgery or ever become a problem. However, then I read this here from the British Hernia Centre, and am now confused: "The most common cases of strangulation are the smaller hernias as the larger ones tend to slide in and out easily, and so are less at risk of being clamped shut by the muscle ‘opening’." Website: https://www.hernia.org/types/strangulated-hernia/
Is it correct that mine is highly unlikely to ever be a problem because it's so small or is it more likely to strangulate because it's so small? Or perhaps, it means that the small ones are less likely to become incarcerated but if they do, then they are more likely to strangulate? Can you clarify all this?
B) Would you recommend surgery in this case?
C) The surgeon said he would do open surgery under general anesthesia, and without mesh. How long do you think after the surgery until I could do brisk walking again? What about jogging? What about driving a car? Thanks.
I am otherwise in good physical shape. I'm 5'5", 130 lbs, and I do a lot of walking and some jogging.
I contacted you March 29th about having both an umbilical rash and hernia. I saw a surgeon and wanted to ask you some more questions. He described the hernia as extremely small (4 to 5 millimeters). He said he didn't think I needed surgery but he would do it if I wanted it. I've read some information since my apt about hernia strangulation that scares me and I'm still thinking of doing the surgery.
A) I thought from everything I read that the smaller hernias were less likely to need surgery or ever become a problem. However, then I read this here from the British Hernia Centre, and am now confused: "The most common cases of strangulation are the smaller hernias as the larger ones tend to slide in and out easily, and so are less at risk of being clamped shut by the muscle ‘opening’." Website: https://www.hernia.org/types/strangulated-hernia/
Is it correct that mine is highly unlikely to ever be a problem because it's so small or is it more likely to strangulate because it's so small? Or perhaps, it means that the small ones are less likely to become incarcerated but if they do, then they are more likely to strangulate? Can you clarify all this?
B) Would you recommend surgery in this case?
C) The surgeon said he would do open surgery under general anesthesia, and without mesh. How long do you think after the surgery until I could do brisk walking again? What about jogging? What about driving a car? Thanks.
I am otherwise in good physical shape. I'm 5'5", 130 lbs, and I do a lot of walking and some jogging.
Brief Answer:
?Umbilical Hernia /Under Evaluation
Detailed Answer:
Brief Ans-?Umbilical Hernia /Under Evaluation
Hi Dear !! Thanks for your query to My Virtual Clinic at HCM.
Read And reviewed this query in context to the current query.
I agree with Your Surgeon as the defect is very small, intervention by open surgery would ask for more incision and more problems related with it.
I would need more information as follows-before I can reply all your queries-asked herein above.
Before I reply your query this time-Please update following information-
What sort of hernia is confirmed from Your Surgeon?Is it Umbilical /Or Para-umbilical/ or Epigastric hernia In Midline just above umbilicus?
How frequently you had complaints till this age?
Update the picture indicating the site and location of hernia?
Do you any time-get abdominal sounds with gases and acidity with pain in abdomen ?
What is your job work?Does it involve more travel and more strenous work?
Update past illness related to this complaint and also any other past illness?
Have you got USG of the hernia to work up the defect size?
Do you have endoscopic surgical facility nearby?
I would love to reply your queries in next session,after getting more information as asked above.
Welcome for any further query in this regard.
Good Day !!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
?Umbilical Hernia /Under Evaluation
Detailed Answer:
Brief Ans-?Umbilical Hernia /Under Evaluation
Hi Dear !! Thanks for your query to My Virtual Clinic at HCM.
Read And reviewed this query in context to the current query.
I agree with Your Surgeon as the defect is very small, intervention by open surgery would ask for more incision and more problems related with it.
I would need more information as follows-before I can reply all your queries-asked herein above.
Before I reply your query this time-Please update following information-
What sort of hernia is confirmed from Your Surgeon?Is it Umbilical /Or Para-umbilical/ or Epigastric hernia In Midline just above umbilicus?
How frequently you had complaints till this age?
Update the picture indicating the site and location of hernia?
Do you any time-get abdominal sounds with gases and acidity with pain in abdomen ?
What is your job work?Does it involve more travel and more strenous work?
Update past illness related to this complaint and also any other past illness?
Have you got USG of the hernia to work up the defect size?
Do you have endoscopic surgical facility nearby?
I would love to reply your queries in next session,after getting more information as asked above.
Welcome for any further query in this regard.
Good Day !!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Above answer was peer-reviewed by :
Dr. Yogesh D
Just so I understand: You're saying the smaller the hernia, the less of a risk it is? My hernia is actually completely asymptomatic and was discovered by accident because I had a belly button rash (which has now cleared up). To answer your questions: It's umbilical. I haven't had any complaints or problems. What I've read about strangulation scares me though. My work isn't physical in nature - I teach college students. I have excellent medical facilities near me (in XXXXXXX PA). I do do some traveling but within the US.
Brief Answer:
Pre-op Work up and planning is needed in your case !!
Detailed Answer:
Brief Ans-Pre-op Work up and planning is needed in your case !!
Hi Dear !! Thanks for your updates on your last query.
Read and reviewed the updates in context to your health concerns and worries about it.
Reply to your updated query-
Just so I understand: You're saying the smaller the hernia, the less of a risk it is? -No, NOt like that.With the small size of umbilical defect-as assessed by your Surgeon-accepting that-the current is risk of Strangulation of the small bowel- in your case, is less .This is what I mean.
Besides this query-My Comments on your case-
I studied your last query 2 weeks back and today's query also.
I find that your umbilical hernia ring defect size -is not yet worked up with abdominal USG study.
It's also important to assess the cause of the rash 2 weeks back.Was it the strangulation of the pre-peritoneal fat or of the mesenteric fatty tissue being entrapped in the herniated contents,which protruded through the small umbilical weakness.
Or was the rash just the result of the improper hygeine and care of the umbilical pit/belly button, in your case ?
Physical Assessment of 4-5 mili meters-as assessed by your Surgeon- could change after the USG assessment of the hernial ring in your case.
Its rare to expect the natural reduction or / healing of the umbilical defect at this age of 36 yrs.Most of the umbilical hernias, heal up by 4-5 yrs of age.Any congenital defect in umbilicus by this age is not going to reduce or heal up.
But with the 4-5 mm size in your case and with the negative history for any complaints in the past in your case, the risks of having further complications -could be restricted by proper care,where by the sudden pressure rises of your intra-abdominal pressure need to be avoided as far as possible.
For this proper repeated USG assessment of Umbilical Ring Weakness would be needed in your case.
But as currently USG assessment of the Umbilical ring size ,causing Weakness is not done in your case, I would suggest you to have it done first, before any further replies are given in your case.
Primary Replies to your A/B/C queries asked-
Still in absence of this information-I would give My replies-in the best possible way-as follows-
Q-A-1-Is it correct that mine is highly unlikely to ever be a problem because it's so small or is it more likely to strangulate because it's so small?
Ans-A-1-No,its not correct that you will not ever have any problem, because of the small umbilical defect- as assessed by your Surgeon-i.e.-4-5 mm by physical check up.Though currently the chances are less because of the size and due to the past history,with increasing age and obesity with it, the umbilical defect may grow and would increase the risks of strangulation of preperitoneal fat or of the mesenteric fat at this size, which is always there right now-even.
Wait and Watch could be the right policy- for 6 mthly reviews with USG assessment of Umbilical Ring weakeness in your case.
Q-A-2-Or perhaps, it means that the small ones are less likely to become incarcerated but if they do, then they are more likely to strangulate? Can you clarify all this?
Ans-A-2-The risk of complications in the umbilical hernias- which are congenital defects or weaknesses in few cases like you,getting strangulated could be kept under control at your age.
But at younger age-where the children are very active and agile, chances of strangulation of the are high because of the agility and activity in the childhood.And in that reference of age of the children, the risks are high with umbilical hernias.
But in your case calculated risk could be taken for the planned surgery at the right moment- as the activity could be kept under control in your case at this age.
But for this Size of the umbilical weakness- needs to be assessed perfectly by USG work up -quarterly or half yearly.
For this one needs to be very patient and Cool minded to execute this Calculated plan of dealing,because the umibilical weakness is very small - with negative history of any complaint in your case.
The choice is your's, which you have to decide.
Q-B) Would you recommend surgery in this case?
Ans-Q-B-I would opt for Calculated plan of -repeated follow up and if need be would suggest Surgical Correction at the right moment and opportune time.
Q-C-1- The surgeon said he would do open surgery under general anesthesia, and without mesh.
Ans-Q-C-1-Surgical tecnique is the subject-when it would be needed at the opportune time.
Besides this Technical Selection is the Choice of individual Surgeon and his confidence and expertise in that technique.
If indicated at the opportune time in your case,I would suggest laparsocopic/ endoscopic correction at best expert hand to avoid complications with mesh surgery, which are almost nil at expert hands.This is because, the procedure is minimally invasive and post-operative recovery is fast with equally best results in expert hands and centers.
Q-C-2-How long do you think after the surgery until I could do brisk walking again?
Ans-C-2-This is the question the reply of which would depend on the open or the endoscopic with or without mesh surgery opted in your case.Hence is hypothetical.
But in general- it would be 3-6 weeks time for the brisk walking after the procedure opted at that time.
Q-C-3-What about jogging? What about driving a car? Thanks.
Ans-C-3-Same as above- but mostly after 3 mths time in general.
Hope this reply would give the way out to plan your surgery in the best possible way in time to come.
Plan for the Next session-
If you want to know exactly on the line of treatment plan-when and which type of surgery exactly- in your case-
Keep Me updated as asked above. I would need USG assessment of the Umibilical Ring weakness in your case.
Do Contact for any further query in this regard by a direct question to ME, at following HCM link-
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
If you have no further query,Do close this query with your praising /excellent feedback comments to rate this reply, to boost the morale of My visiting patients like You, at HCM Virtual forum.
Good Day!!
Wishing Good Healthy Life!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Pre-op Work up and planning is needed in your case !!
Detailed Answer:
Brief Ans-Pre-op Work up and planning is needed in your case !!
Hi Dear !! Thanks for your updates on your last query.
Read and reviewed the updates in context to your health concerns and worries about it.
Reply to your updated query-
Just so I understand: You're saying the smaller the hernia, the less of a risk it is? -No, NOt like that.With the small size of umbilical defect-as assessed by your Surgeon-accepting that-the current is risk of Strangulation of the small bowel- in your case, is less .This is what I mean.
Besides this query-My Comments on your case-
I studied your last query 2 weeks back and today's query also.
I find that your umbilical hernia ring defect size -is not yet worked up with abdominal USG study.
It's also important to assess the cause of the rash 2 weeks back.Was it the strangulation of the pre-peritoneal fat or of the mesenteric fatty tissue being entrapped in the herniated contents,which protruded through the small umbilical weakness.
Or was the rash just the result of the improper hygeine and care of the umbilical pit/belly button, in your case ?
Physical Assessment of 4-5 mili meters-as assessed by your Surgeon- could change after the USG assessment of the hernial ring in your case.
Its rare to expect the natural reduction or / healing of the umbilical defect at this age of 36 yrs.Most of the umbilical hernias, heal up by 4-5 yrs of age.Any congenital defect in umbilicus by this age is not going to reduce or heal up.
But with the 4-5 mm size in your case and with the negative history for any complaints in the past in your case, the risks of having further complications -could be restricted by proper care,where by the sudden pressure rises of your intra-abdominal pressure need to be avoided as far as possible.
For this proper repeated USG assessment of Umbilical Ring Weakness would be needed in your case.
But as currently USG assessment of the Umbilical ring size ,causing Weakness is not done in your case, I would suggest you to have it done first, before any further replies are given in your case.
Primary Replies to your A/B/C queries asked-
Still in absence of this information-I would give My replies-in the best possible way-as follows-
Q-A-1-Is it correct that mine is highly unlikely to ever be a problem because it's so small or is it more likely to strangulate because it's so small?
Ans-A-1-No,its not correct that you will not ever have any problem, because of the small umbilical defect- as assessed by your Surgeon-i.e.-4-5 mm by physical check up.Though currently the chances are less because of the size and due to the past history,with increasing age and obesity with it, the umbilical defect may grow and would increase the risks of strangulation of preperitoneal fat or of the mesenteric fat at this size, which is always there right now-even.
Wait and Watch could be the right policy- for 6 mthly reviews with USG assessment of Umbilical Ring weakeness in your case.
Q-A-2-Or perhaps, it means that the small ones are less likely to become incarcerated but if they do, then they are more likely to strangulate? Can you clarify all this?
Ans-A-2-The risk of complications in the umbilical hernias- which are congenital defects or weaknesses in few cases like you,getting strangulated could be kept under control at your age.
But at younger age-where the children are very active and agile, chances of strangulation of the are high because of the agility and activity in the childhood.And in that reference of age of the children, the risks are high with umbilical hernias.
But in your case calculated risk could be taken for the planned surgery at the right moment- as the activity could be kept under control in your case at this age.
But for this Size of the umbilical weakness- needs to be assessed perfectly by USG work up -quarterly or half yearly.
For this one needs to be very patient and Cool minded to execute this Calculated plan of dealing,because the umibilical weakness is very small - with negative history of any complaint in your case.
The choice is your's, which you have to decide.
Q-B) Would you recommend surgery in this case?
Ans-Q-B-I would opt for Calculated plan of -repeated follow up and if need be would suggest Surgical Correction at the right moment and opportune time.
Q-C-1- The surgeon said he would do open surgery under general anesthesia, and without mesh.
Ans-Q-C-1-Surgical tecnique is the subject-when it would be needed at the opportune time.
Besides this Technical Selection is the Choice of individual Surgeon and his confidence and expertise in that technique.
If indicated at the opportune time in your case,I would suggest laparsocopic/ endoscopic correction at best expert hand to avoid complications with mesh surgery, which are almost nil at expert hands.This is because, the procedure is minimally invasive and post-operative recovery is fast with equally best results in expert hands and centers.
Q-C-2-How long do you think after the surgery until I could do brisk walking again?
Ans-C-2-This is the question the reply of which would depend on the open or the endoscopic with or without mesh surgery opted in your case.Hence is hypothetical.
But in general- it would be 3-6 weeks time for the brisk walking after the procedure opted at that time.
Q-C-3-What about jogging? What about driving a car? Thanks.
Ans-C-3-Same as above- but mostly after 3 mths time in general.
Hope this reply would give the way out to plan your surgery in the best possible way in time to come.
Plan for the Next session-
If you want to know exactly on the line of treatment plan-when and which type of surgery exactly- in your case-
Keep Me updated as asked above. I would need USG assessment of the Umibilical Ring weakness in your case.
Do Contact for any further query in this regard by a direct question to ME, at following HCM link-
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
If you have no further query,Do close this query with your praising /excellent feedback comments to rate this reply, to boost the morale of My visiting patients like You, at HCM Virtual forum.
Good Day!!
Wishing Good Healthy Life!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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