Should my child have surgery for an umbilical hernia?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Deciding whether your child needs surgery for an umbilical hernia depends on whether it is likely to heal on its own and whether its appearance bothers you or your child.

Consider the following when making your decision:

• There is a good chance that your child's umbilical hernia may close on its own. In most cases, hernias that are present before 6 months of age disappear by 1 year of age.¹
• Your child may need surgery if the hernia is very large or if a hernia of any size has not gone away by age 4 or 5.
• You may choose to have the hernia corrected for social or cosmetic reasons. If your child's umbilical hernia is very unusual-looking or bothersome, it can be surgically corrected before age 4 or 5.
• Your child probably faces no health risks from an umbilical hernia, unless he or she develops infection or other complications, such as rupture of the hernia or trapping of the intestines in the hernia sac. But these are relatively rare.

Medical Information

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What is an umbilical hernia?

An umbilical hernia is a bulge in the abdominal wall within the navel. The hernia sometimes contains tissue that lines the inside of the abdomen, a loop of intestine, fat, or fluid. This tissue protrudes through an opening or weak spot in the abdominal wall where the umbilical cord was attached during fetal development. This weak spot forms when muscle and other tissue around the umbilical cord do not close properly.

Umbilical hernias are estimated to occur in about 15% of all children.² Babies who weigh less than at birth are more likely to have umbilical hernias than babies who weigh more.¹ Most often these smaller babies are born early (premature). Other reports indicate that between 2% and 10% of all children have an umbilical hernia at 1 year of age.³ An umbilical hernia is not painful. It does not pose any health risks except for very rare cases when complications, such as strangulation or rupture, develop.

Umbilical hernias almost always resolve on their own as a child's abdominal muscles develop; however, they sometimes require surgical repair.

What are the risks of surgery for an umbilical hernia?

The surgery to repair an umbilical hernia is considered a safe procedure with relatively little risk. During the procedure, a small incision is made just below the navel (umbilicus). Any loops of intestine and other tissue that have protruded into the hernia sac are pushed back inside the abdomen. The muscles and connective tissues of the umbilical ring are then repaired, and the incision is closed.

The procedure is done using general anesthesia, usually on an outpatient basis (your child will go home the same day).

Usually there is only a small scar from the surgery, and it is often located inside the navel where it is not noticeable. Surgery to repair a very large umbilical hernia or a proboscoid hernia (an umbilical hernia in which a large amount of extra skin overlies the hernia and forms a prominent protrusion on the belly) may result in a navel that appears somewhat abnormal. In these cases, surgical techniques can help provide a navel that is very nearly normal in appearance.

What factors influence whether an umbilical hernia will heal on its own?

Although most umbilical hernias heal on their own, some are more likely to require surgery, such as those that:

• Measure or greater. Umbilical hernias vary in size from less than to more than across. Those that measure or more are less likely to close on their own.¹
• Develop after 6 months of age or become progressively larger after 1 to 2 years of age.¹
• Cause symptoms or have developed complications. Incarceration, also called strangulation, is a major complication, because part of the intestine or abdominal tissue becomes trapped in the hernia sac and loses its blood supply. An extremely rare complication is when the skin over the hernia breaks open, or ruptures, exposing the tissue inside the hernia sac.
• Remain after your child is 4 to 5 years of age. If they have not resolved on their own by this age, they probably will not do so.
• Are bothersome to you or your child. Some umbilical hernias are proboscoid, which have an excess amount of skin overlying the hernia. These types of hernias often are very unusual in appearance and more noticeable than other types of umbilical hernias.

If you need more information, see the topic Umbilical Hernia in Children.

Your Information

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Your choices are:

• Wait and see if the umbilical hernia heals on its own.
• Pursue surgical repair of the hernia. This may be before your child is age 4 or 5 years.

The decision whether to have surgery for an umbilical hernia takes into account your personal feelings and the medical facts.

Deciding about surgery for your child

Reasons to have surgery

Reasons to not have surgery

Your child is between ages 4 and 5 years, and the hernia has not closed. The umbilical hernia measures or greater across and has not shown signs of closing by the time your child is 2 years old. The hernia developed after 6 months of age and shows no signs of closing. Your child is older than age 1 year, and the hernia is progressively getting larger. Your child has developed complications, such as strangulated or ruptured tissue, or other symptoms or health risks, such as those related to infection. You or your child is bothered by the hernia's unusual appearance. Are there other reasons that you might want to have your child's umbilical hernia surgically repaired?

Your child is not yet between 4 and 5 years of age. The hernia measures less than across. Your child's umbilical hernia developed before 6 months of age and is showing signs of closing. Your child is over age 1 year, and the hernia is not getting larger. No complications or other health risks related to the hernia have developed. Your child does not seem to be bothered by the umbilical hernia, even if it is large or has an unusual appearance.   Are there other reasons that you might not want to have your child's umbilical hernia surgically repaired?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery for your child's umbilical hernia. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

The umbilical hernia is small [less than ].	Yes	No	Unsure
The hernia developed before my baby was 6 months of age.	Yes	No	Unsure
No signs of complications, infections, or other health risks have developed.	Yes	No	Unsure
The appearance of the umbilical hernia doesn't bother me or my child.	Yes	No	Unsure
My child doesn't really pay much attention to the hernia.	Yes	No	Unsure
My child is younger than 4 years of age.	Yes	No	N/A*
The hernia has shown signs of closing.	Yes	No	Unsure
My child is over age 1 and the umbilical hernia is not getting larger.	Yes	No	Unsure
I am okay with my child being given general anesthesia.	Yes	No	Unsure

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to choose or not choose surgery for an umbilical hernia.

Check the box below that represents your overall impression about your decision.

Leaning toward surgery for my child's umbilical hernia

Leaning toward NOT having my child undergo surgery

Return to the topic Umbilical Hernia in Children.

References

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Citations

1. Stoll BJ, Kliegman RM (2004). The umbilicus. In RE Behrman et al., eds., Nelson Textbook of Pediatrics, 17th ed., pp. 608. Philadelphia: Saunders.

2. Papagrigoriadis S, et al. (1998). Incarceration of umbilical hernias in children: A rare but important complication. Pediatric Surgery International, 14(3): 231–232.

3. Marion RW (2001). Umbilical hernia section of Umbilical anomalies. In RA Hoekelman et al., eds., Primary Pediatric Care, 4th ed., p. 1891. St. Louis: Mosby.

Credits

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Author	Amy Fackler, MA
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Brad W. Warner, MD - Pediatric Surgery
Last Updated	February 15, 2006