Umbilical and epigastric hernia

Hernias develop when there is a weak area in the abdomen or a small opening in the abdominal muscles, causing the tissues below to bulge. Both children and adults can have hernias. This page explains hernias, how they can be treated and what to expect when a child comes to Great Ormond Street Hospital (GOSH).

Hernias occur when a weak area of muscle allows the internal organs to push outwards to form a bulge. This weak area develops in different ways, depending on the area of the abdomen. We do not know exactly why this happens, but it is not due to anything that happened during pregnancy.

• Umbilical hernias form when the opening for the umbilical cord does not closely properly so allow the abdominal lining and bowel to bulge out to form a lump.
• Epigastric hernias form when tissues joining the muscles in the upper part of the abdomen have not formed properly and allow fatty tissue to bulge out to form a lump.

A doctor will be able to diagnose the hernia by clinical examination as it appears as a characteristic lump in the child’s abdomen. The child may not need any further diagnostic investigations.

The opening for the umbilical cord continues to close after a baby is born so may not need treatment. If an umbilical hernia is still present by the time a child is three years old, an operation to repair it will usually be suggested. Epigastric hernias are usually repaired only if they are causing discomfort or getting in the way of normal everyday life and activities.

If required, hernias can be treated in an operation under general anaesthetic, lasting between 30 minutes and an hour. In many cases, this can be as day surgery – a child will arrive at the hospital, have the operation and be able to go home on the same day. Occasionally a child will need to stay in hospital overnight.

If surgery is planned, parents will receive information about how to prepare children for the operation in the admission letter and booklet. The child should not have anything to eat or drink beforehand for the amount of time specified in the letter or telephone call. It is important to follow these instructions - otherwise the child’s operation may need to be delayed or even cancelled.

On admission day, the child’s surgeon will explain the operation in detail, discuss any worries and ask permission for the operation, by asking for a consent form to be signed. An anaesthetist will explain the child’s anaesthetic in more detail. If the child has any medical problems,such as allergies, please tell the doctors.

Umbilical and epigastric hernias are usually repaired using open surgery.

The surgeon will repair an umbilical hernia by making a small incision in a natural skin crease near the tummy button, using stitches to close the opening. If the abdominal lining and bowel are sticking out, the surgeon will push them back before closing the opening.If an epigastric hernia needs repair, the surgeon will first mark the affected area on the skin using pen. This is important because the hernia may become less obvious when a child is under a general anaesthetic. The surgeon will repair the epigastric hernia by making an incision over the area, pushing the fatty tissue back inside and repairing the opening with stitches.In both cases, the skin incision will be closed using dissolvable stitches and steri-strips®, sometimes with skin glue as well.

Any surgery also carries a small risk of infection or bleeding. The area may be sore and bruised for a while after the operation but this will become more comfortable and fade over the next week or so. If there is bruising under the skin after an umbilical hernia repair, a pressure dressing may be used to reduce this.

Every anaesthetic carries a risk of complications, but this is very small. The child’s anaesthetist is an experienced doctor who is trained to deal with any complications. After an anaesthetic, a child may feel sick and vomit, have a headache, sore throat or feel dizzy. These effects are usually short-lived.Very occasionally, the hernia can return which would require further investigation and surgery.

The child will come back to the ward to recover, and will be able to go home once he or she has had something to eat and drink. When the children get home It is quite normal for them to feel uncomfortable for a day or two after the operation. Usually paracetamol will be enough to relieve any pain if given regularly according to the instructions on the bottle. Children do not need to wake during the night for medicine. If a child needs stronger medicine, it will be provided before he or she goes home.

Children may feel sick for the first 24 hours after the anaesthetic. They should be encouraged drink plenty of fluids, and as long as they are drinking, it does not matter if they do not feel like eating for the first couple of days. The stitches will dissolve on their own within two weeks or so. The wound site may be closed by steri-strips® (plastic strips which are stuck on the skin and used, like stitches, to close wounds). The steri-strips® usually fall off of their own accord. If they have not fallen off within a week, they can be soaked off using a wet flannel. The skin glue usually flakes away over a period of days. The child should not have a bath or shower for two days after the operation. After this, it is fine for the child to have a shower, but try to avoid long baths as this may cause the scab to soften and fall off too early.

Children may feel tired and a bit clumsy for the first day or so after the operation, so avoid anything that might lead to a fall. Rough and tumble play will be uncomfortable so should be avoided until the area has healed. should be ready to go back to school or nursery about a week after the operation.

Call the family doctor (GP) or the ward if:

• the child is in a lot of pain and pain relief does not seem to help
• the child has a high temperature and paracetamol does not bring it down
• the wound site looks red, inflamed and feels hotter than the surrounding skin
• there is any oozing from the wound