What is Open Umbilical Hernia Repair?

Open umbilical hernia repair is a surgical procedure that fixes your hernia through a small incision near your belly button. The surgeon pushes the bulging tissue back into place and strengthens the weak area to prevent the hernia from coming back.

There are two main ways to repair an umbilical hernia:

Suture Repair (Primary Closure):

The surgeon uses stitches alone to close the hole in your abdominal wall. This may be appropriate for very small hernias (less than 1 cm).

Mesh Repair:

The surgeon places a piece of synthetic mesh (usually made of polypropylene) over or behind the weak area to reinforce it. This is the recommended approach for most umbilical hernias.

How Does the Surgery Work?

During an open umbilical hernia repair:

1. You’ll receive either local anesthesia with sedation (you’re awake but relaxed and numb) or general anesthesia (you’re asleep)
2. The surgeon makes a small curved incision around or below your belly button, typically 2-4 inches long
3. The hernia sac is identified and the bulging tissue is pushed back into your abdomen
4. The surgeon examines the area to measure the size of the defect
5. For mesh repair: A flat piece of mesh is placed either on top of the muscle (onlay), behind the muscle (sublay/retromuscular), or behind the abdominal lining (preperitoneal) to reinforce the weak area
6. For suture repair: The edges of the hole are sewn together with strong stitches
7. The incision is closed with stitches

The procedure typically takes 20-45 minutes for most umbilical hernias.[4]

Should I Have Mesh or Suture Repair?

Current guidelines and research strongly support using mesh for most umbilical hernias. Here’s what the evidence shows:

Mesh Reduces Recurrence:

A major clinical trial found that mesh repair reduces the risk of hernia recurrence by about 70% compared to suture repair. After 2 years:

• Mesh repair: 4% recurrence rate
• Suture repair: 12% recurrence rate

This means that for every 13 patients who have mesh repair instead of suture repair, one hernia recurrence is prevented.

Even for Small Hernias:

Research shows that mesh repair significantly decreases recurrence even for the smallest umbilical hernias (1 cm or less)

• Mesh repair: 2-3% recurrence rate
• Suture repair: 6-7% recurrence rate

Current Recommendations:

The European Hernia Society and Americas Hernia Society recommend mesh repair for umbilical hernias with defects 1 cm or larger.For hernias smaller than 1 cm, suture repair may be considered, but mesh still provides better protection against recurrence.

What Are the Benefits of Open Umbilical Hernia Repair?

Open repair offers several advantages:

• Proven technique: Has been performed successfully for decades with excellent results
• Can be done under local anesthesia: Many patients can have this surgery while awake, avoiding the risks of general anesthesia
• Same-day surgery: Most patients (75%) go home the same day
• Low recurrence rates: With mesh, recurrence rates are only 2-4%
• Lower risk of serious complications: Compared to laparoscopic repair, open repair has fewer severe complications like bowel injury
• Better quality of life outcomes: Studies show patients report less pain and better overall quality of life compared to laparoscopic repair

What Should I Expect for Recovery?

Day of Surgery:

• 75% of patients go home the same day (0 days in hospital)
• 20% stay overnight (1 day)
• Only 5% stay longer than 1 day

First Few Days:

• You may have some soreness, swelling, and bruising around your belly button—this is normal
• Most patients can walk and perform light daily activities within 1-2 days
• Pain is typically well-controlled with over-the-counter or prescription pain medication

First Few Weeks:

• Return to work: 1-2 weeks for desk work; 2-4 weeks for physical labor
• Most patients return to normal daily activities within 1-2 weeks

Returning to Full Activity:

• Strenuous exercise and heavy lifting are typically restricted for 2-4 weeks
• Your surgeon will give you specific instructions based on your individual situation