An umbilical hernia refers to a hernia in which the hernial sac protrudes through the umbilical ring. Umbilical hernias can be classified into pediatric umbilical hernias and adult umbilical hernias, with different causes and treatment principles for each.
The cause of pediatric umbilical hernia is incomplete closure of the umbilical ring or insufficiently robust scar tissue at the umbilicus, leading to herniation under conditions of increased intra-abdominal pressure. Pediatric umbilical hernias are often reducible and clinically present as protrusion of the umbilical hernia during crying, which disappears when the child is calm.
Observation has shown that in most cases, an unclosed umbilical ring will naturally close by the age of two. Therefore, except in urgent situations such as incarceration or perforation, non-surgical treatment can be considered before the age of two. After two years of age, surgical treatment can be performed if the umbilical ring diameter remains greater than 1.5 cm. In general, umbilical hernias in children over five years of age should be treated surgically.
The principle of non-surgical treatment involves reducing the hernial contents and then pressing a gauze-wrapped hard object, such as a coin or small wooden piece larger than the umbilical ring, against the umbilical ring, which is then fixed in place with adhesive tape or a bandage.
Adult umbilical hernias are acquired hernias and are relatively rare. They are more commonly observed in middle-aged multiparous women. The small size of the hernial ring in adult umbilical hernias often leads to a higher incidence of incarceration or strangulation, necessitating surgical treatment. In pregnant women or patients with ascites due to liver cirrhosis, spontaneous or traumatic rupture of an umbilical hernia may occasionally occur.
The principle of surgical repair for umbilical hernias involves excision of the hernial sac and closure of the hernial ring, with overlapping suturing of adjacent tissues on either side of the hernial ring if necessary. During the procedure, preservation of the umbilicus is important to avoid potential psychological impact, particularly in children.