Pediatric Umbilical Hernia

A reducible hernia can be pushed back into the opening or decrease in size when lying flat. When intestine or abdominal tissue fills the hernia sac and cannot be pushed back, it is called irreducible or incarcerated. A hernia is strangulated if the intestine is squeezed in the hernia pouch and the blood supply to the intestine is cut off. This is a surgical emergency.¹ A congenital hernia develops in the fetus during pregnancy and is present at birth.

Umbilical hernias are one of the most common conditions in children. They occur equally among boys and girls and in 15 to 23% of newborns. They are very common in African-American, Hispanic and low birth-weight infants.

The risk of incarceration of umbilical hernia in children is rare (less than 1 in 100) but premature infants have 2x the risk. More than 2/3 of incarcerations occur before age 1 year.

Common Symptoms

A bulge in the abdominal area that often increases with crying or straining.
An umbilical hernia usually does not cause pain in children.²
Increasing sharp abdominal pain and vomiting can mean that the hernia is strangulated. This is a surgical emergency and immediate treatment is needed.

Treatment Options

Surgical Procedure

Open Hernia Repair

An incision is made along the inferior edge of the umbilicus. The surgeon will repair the hernia by suturing (sewing) the muscle closed.

Non-Surgical Treatment

Watchful Waiting

Many small (< 1-1.5 cm) umbilical hernias will close on their own as the child grows between birth and 4 years of age, eliminating the need for surgical repair. Umbilical hernias often resolve over time and watchful waiting may be advised until the 5th birthday.³

Benefits and Risks of Your Child's Operation

Benefits

An operation is the only way to repair a hernia that has not closed on its own. A child will be able to return to their normal activities in a short amount of time, and, in most cases, discomfort from the procedure will last only a few days.

Risks of not Having an Operation

The hernia may cause pain and increase in size. If the intestine becomes squeezed in the hernia sac (incarceration), there may be sudden pain, vomiting, and the need for an immediate operation.

Possible Risks

Complications are rare. There is a very small rate of wound infection and hematoma (collection of blood) after an umbilical hernia repair in children. There may also be a 2% risk of recurrence on long term follow up.³

Expectations

Before the operation—Evaluation may include blood work and urinalysis. The surgeon and anesthesia provider will discuss your child’s health history, home medications, and pain control options.

The day of the operation—Your child will not eat or drink for six hours before the operation (verify the recommended time with your surgeon or anesthesiologist). Check with the doctor’s office to see if your child should take their routine medication. A parent can usually stay with the child in the OR waiting area and again during recovery.

Your child's recovery—Your child will likely go home from the recovery room within a few hours for small hernia procedures but may need to stay in the hospital longer following complex repairs.

Call your surgeon if your child has:

Severe pain, pain that will not go away, or pain that gets worse
Swelling of the abdomen
Stomach cramping
Vomiting
Chills or a high fever (over 101°F or 38.3°C)
Swelling, redness, bleeding, or bad smelling drainage from the wound site
No bowel movements for three days

Surgical Treatment

The type of operation depends on hernia size, location, and if it is a repeat hernia. The child’s age, health, anesthesia risk, and the surgeon’s expertise are also important. Surgical repair is usually performed by a pediatric general surgeon. An operation is the only treatment for a hernia repair. Surgical repair of an umbilical hernia in children may be needed if:

The hernia is painful and stuck in a bulging position (incarcerated)
Blood supply is affected (strangulated)
The hernia has not closed by age 5
The defect is large or bothersome in appearance²

Open Hernia Repair

Suture repair is the primary type of umbilical hernia repair for infants and children. The surgeon makes an incision near the hernia site, and the bulging tissue is gently pushed back into the abdomen. Sutures are used to close the muscle.

Pushing the umbilical hernia back into the abdomen and taping or strapping a coin to the umbilical area to try to close the hernia is not effective and is not recommended.

For suture-only repair (Herniorrhaphy): The hernia sac is removed. And the tissue along the muscle edge is sewn together. The umbilicus is then fixed back to the muscle. This procedure is often used for small defects.
The skin is closed using subcuticular absorbable sutures or surgical glue.
General anesthesia is typically required to perform the surgical repair.

Nonsurgical Treatment

Watchful waiting is recommended for children who have no symptoms. In 95% of cases, umbilical hernias less than 1 cm in diameter close on their own within 5 years of age⁵. After age 5, repair is recommended.

Fluids and Anesthesia

Let your anesthesia provider know if your child has allergies, neurologic disease (epilepsy), heart disease, stomach problems, lung disease (asthma), endocrine disease (diabetes, thyroid conditions), loose teeth and any medications they are taking. An intravenous line (IV) will be started to give your child fluids and medication. This is usually inserted after your child is asleep in the operating room.

General anesthesia is most often used, and your child will be asleep and pain free for this surgery. A tube will be placed down your child’s throat to help your child breathe during the operation. For spinal anesthesia, a small needle with medication will be placed in their back alongside the spinal column. They will be awake but pain free.

Length of Stay

If your child is having local anesthesia, they will usually go home the same day. They may need to stay longer if they have had laparoscopic surgery with general anesthesia, a larger hernia with mesh repair, an incarcerated hernia, nausea, or vomiting. All hospitals allow a parent to stay overnight in a room with their child.

Risks Based on the ACS Risk Calculator

Open and Laparoscopic Umbilical Hernia Surgery from the ACS Risk Calculator – March 30, 2022

Risks	What Can Happen	Keeping You Informed
Immediate postoperative pain	Postoperative pain following umbilical hernia repair in children is not severe and lasts only a few days.⁴	Your child may receive some “numbing medicine” (local anesthetic) at the surgery site. Sometimes this can be used to numb the surrounding area (a regional block). Most children only need ibuprofen or Tylenol for pain for a few days, taken by mouth every 4-6 hours if needed.
Long-term pain	There are no reports of long-term pain in follow-up visits up to one year after repair.	Your child’s pain should decrease within a few days. Follow up with the doctor if your child is still uncomfortable.
Sedation and anesthesia	Breathing problems such as decreased oxygen levels, stridor (noisy breathing) and spasms of the larynx, or apnea (temporary lack of breathing) occurred in less than 1 in 100 pediatric surgeries. Increased secretions or vomiting occurred in less than 1 in 100 pediatric sedation or anesthesia procedures.⁷ Serious adverse effects were rare, and no deaths were reported in over 30,000 cases.⁸ Your child’s anesthesia provider will suggest the best option.	Breathing, heart rate and rhythm, body temperature, blood pressure, and blood oxygen levels will be checked throughout the surgery. After general anesthesia, kids go to the post-anesthesia care unit (PACU) or recovery room. Parents or caregivers can join their child here and be with them while they wake up. Your child may feel groggy and a little confused when waking up. Other common side effects can include nausea or vomiting, chills or shakiness, or a sore throat (from the breathing tube).
Seroma	A seroma (collection of fluid) occurred in .02% of repairs.⁴	Seromas can form around the former hernia site. Most seromas will disappear on their own. Removal of fluid with a sterile needle may be required.
Hematoma	A hematoma (collection of blood) occurred in .06% of cases of pediatric umbilical hernia repair.⁴	A pressure dressing may be applied for a few days after surgery. Currently, there is no evidence that a pressure dressing decreases the risk of developing a hematoma.⁹
Infection	Wound infections occurred in .07% of repairs in children.¹⁰	The incision will be held together with Steri-strips and covered with a clear dressing.⁴ Wash hands before caring for the incision site. Notify the doctor’s office of any signs of infection such as fever, pain, redness, or swelling at the site.
Incarceration and strangulation	Both incarceration and strangulation requiring emergency surgery occur in less than 1 in 100 children with umbilical hernias.¹¹	Surgical outcome is good in children, even with incarcerated or strangulated hernias, as long as fluid and electrolyte balance is corrected and the hernia is repaired quickly.¹⁰
Recurrence (hernia comes back)	There is a 2% chance that the hernia will come back after umbilical hernia repair.	Laparoscopic repair is recommended for recurrent hernias, as the surgeon avoids previous scar tissue.
Death	No surgical deaths are reported directly related to umbilical hernia repair in children.	Your surgical team will closely monitor your child for any complications.

The Day of Your Procedure

Get the details you need about common procedures and know what to expect before you or a loved one has surgery.

Recovery and Discharge

Access resources and information you need to optimize your recovery from surgery.

Safe Pain Management

Your surgical team wants to help you to safely and effectively manage any pain that you may have after surgery.

Surgery FAQ

Answers to common questions surgical patients have before, during, and after a procedure.

Glossary

Blood tests: Tests usually include a Chem-6 profile (sodium, potassium, chloride, carbon dioxide, blood urea nitrogen and creatinine) and complete blood count (red blood cell and white blood cell count).

General anesthesia: A treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery.

Hematoma: A collection of blood that has leaked into the tissues of the skin or in an organ, resulting from cutting in surgery or the blood’s inability to form a clot.

Local anesthesia: The loss of sensation only in the area of the body where an anesthetic drug is applied or injected.

Seroma: A collection of serous (clear/yellow) fluid.

Urinalysis: A visual and chemical examination of the urine, most often used to screen for urinary tract infections and kidney disease.

DISCLAIMER

The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The ACS endeavors to provide procedure education for prospective patients and those who educate them. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. The ACS makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard.

Reviewed and updated 2014, 2018 and 2022:
Nancy Strand, MPH, RN
Kathleen Heneghan, PhD, MSN, RN, FAACE Marshall Z. Schwartz, MD, FACS
Mary E. Fallat, MD, FACS

Revised: April 2022

References

The information provided in this brochure is chosen from recent articles based on relevant clinical research or trends. The research listed below does not represent all of the information that is available about your procedure. Ask your doctor if he or she recommends that you read any additional research.

Lao OB, Fitzgibbons RJ Jr, Cusick RA. Pediatric Inguinal Hernias, Hydroceles, and Undescended Testicles. Surgical Clinics of North America. 2012;92(3):487-504.
Umbilical Hernia Surgery for Children. https://my.clevelandclinic.org/health/treatments/6241-umbilical-hernia-surgery-forchildren Accessed April 27, 2022.
Zens TJ, Rogers A, Cartmill R, Ostlie D, Muldowney BL, Nichol P, Kohler JE. Age-dependent outcomes in asymptomatic umbilical hernia repair. Pediatr Surg Int. 2019 Apr;35(4):463-468. doi: 10.1007/s00383-018-4413-3.
Zendejas B, Kuchena A, Onkendi EO, etal. Fifty-three-year experience with pediatric umbilical hernia repairs. J Pediatr Surg. 2011 Nov;46(11):2151-6.
Troullioud Lucas AG, Jaafar S, Mendez MD. Pediatric Umbilical Hernia. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022
Managing a Child’s Pain After Surgery: Parent FAQs. https://www.healthychildren.org/English/healthissues/conditions/treatments/Pages/Managing-a-Childs-Pain-After-Surgery.aspx Accessed April 28, 2022.
Cravero JP, Blike GT, Beach M, Gallagher SM, Hertzog JH, Havidich JE, Gelman B. Incidence and nature of adverse events during pediatric sedation. Pediatrics. 2006;118:1087-1096. Doi: 10.1542/peds.2006-0313.
Anesthesia. https://kidshealth.org/en/parents/anesthesia-basics.html. Accessed April 28, 2022.
O’Neill,. Umbilical Hernia. Principles of Pediatric Surgery., 2013. Retrieved from http://www.pediatricsurgerymd.org.
Chirdan LB, Uba AF, Kidmas AT. Incarcerated Umbilical Hernia in Children. Journal of Pediatric Surgery. 2006;16:45-48.
Abdulhai SA, Glenn IC, Ponsky TA. Incarcerated Pediatric Hernias. Surg Clin North Am. 2017 Feb;97(1):129-145.