What is an umbilical hernia?
An umbilical hernia is a condition where a weak spot forms in the abdominal cavity near the belly button, allowing for a section of the intestine to push through the weakened wall. This can develop in both children and adults. In rare cases, an umbilical hernia can progress to a strangluation, which is a serious condition where bloodflow is cut off from the section of the intestine, eventually leading to necrosis (tissue dying). The symptoms of strangulation include pain, nausea and vomiting [1].
Clinically, umbilical hernia presents as a bulge or a pouch forming near the belly button. This may be skin-coloured, or blue, resembling a bruise. Additionally, umbilical hernias may cause pain.
Umbilical Hernia Surgery
As with any health condition, early intervention markedly improves the therapeutic outcome, in this case reducing the risk of strangulation of the intestine. The only way to manage a hernia is surgery. This can be performed in two ways: open repair or laparoscopic surgery. In the open approach, the surgeon makes an incision near the belly button to access the hernia. In the laparoscopic approach, multiple very small incisions are made, and tubes with a camera and instruments are inserted through these small incisions [1].
Regardless of the approach, the procedure to repair the hernia is the same. The bulging intestine is gently pushed back into the abdominal cavity, and the weakened abdominal wall is stitched together and reinforced. In some cases, particularly for larger hernias, a synthetic mesh can be inserted to reinforce the site of the hernia [1].
Can you die from umbilical hernia surgery?
In short, yes, patients can die from umbilical hernia repair surgery, as with any other surgery. However, this surgery is fairly safe, with the mortality being relatively low.
A study on 14,752 adult patients and 6,490 elderly patients who were hospitalized for umbilical hernia concluded that the overall mortality was 0.8% in the adult group and 2.8% in the elderly group [2]. However, another study involving 3229 patients reported a higher mortality rate of 6% after undergoing umbilical hernia repair [3].
As with any other disease or surgery, the outcome relies on multiple factors, including the patient's overall health. For example, in patients with cirrhosis of the liver, the mortality rate is eight times that of patients without cirrhosis [3].
Causes of death following hernia repair
The causes of death following umbilical hernia repair surgery are influenced by multiple factors. In the patients with cirrhosis, manifestation of pulmonary disease and sepsis were common causes of death. However, it is worth noting that these adverse effects were more common after emergency hernia repair, therefore underlining the importance of early intervention [4].
A study on 332 patients with military background who underwent emergency hernia repair surgery established that the factors associated with higher mortality were older age, smoking, liver disease, ascites, emergency or semiurgent repair, and need for intraoperative bowel resection [4].
How to reduce mortality in hernia surgery?
Despite umbilical hernia repair being a relatively common surgery, it still carries the risk of mortality. However, healthcare profesionals aim to minimise this risk, therefore, several factors that positively influence the outcome were identified.
Firstly, the timing of the surgery. It is now well established that emergency hernia repairs carry an increased risk of mortality. However, elective hernia repair surgery was associated with better outcomes. In fact, about 30% of all emergency hernia repair cases were likely candidates for surgery for the whole year prior to the emergency surgery [5]. Therefore, it is very important to get all suspicious findings that may be a hernia evaluated by a doctor, and if hernia repair needs to be performed, it should not be delayed.
Secondly, the choice of the anaesthetic has been found to be associated with outcomes. A study found that using local rather than general anesthesia was associated with a 12%-24% faster operative time for all patients, and an 86% lower complication rate for frail patients [6].
Thirdly, the surgical approach. The laparoscopic approach appears to be safer, with an observed decrease in mortality (though sometimes may be associated with longer hospital stay, interestingly) [7].
Finally, the use of a mesh in the surgery can influence outcomes. Though not directly associated with mortality, the use of mesh reinforcement is recommended for larger hernias. However, the use of mesh is a controversial subject in the surgical community for smaller umbilical hernias [8].
Summary
While an umbilical hernia repair is a safe procedure, there is a small risk of death from the procedure, as with any other surgery. It is important to not delay a hernia repair, as this has been associated with improved outcomes and reduced risk of mortality.