Umbilical Hernia

The European Hernia Society defines umbilical hernias as ventral abdominal hernias located from 3 cm above to 3 cm below the umbilicus. Umbilical hernias account for 6% to 14% of all adult abdominal wall hernias and are second in frequency only to inguinal hernias. Umbilical hernias occur in 10% to 15% of infants and often resolve spontaneously by 2 years of age. Those umbilical hernias that have not closed by 5 years of age or are larger than 1.5 cm in diameter may require surgical intervention. The scope of this review will be limited to umbilical hernias in adults. For the evaluation and management of umbilical hernias in children, please see our companion StatPearls reference article on "Pediatric Umbilical Hernia."

The European and American Hernia Societies classify umbilical hernias in adults by size. A small hernia is considered to be < 1 cm in diameter, medium between 1 and 4 cm, and large hernias measure > 4 cm. The hernia sac often contains preperitoneal fat or omentum but may also contain a portion of the small intestine or, less commonly, the colon.

Many people are diagnosed with an umbilical hernia during a routine physical examination. If the hernia is asymptomatic, affected individuals often choose expectant management over surgical repair. However, 65% of adult patients with an umbilical hernia will eventually require surgical repair; 3% to 5% of these repairs will be emergent. Individuals with an asymptomatic umbilical hernia should be counseled on the signs and symptoms of incarceration and strangulation and instructed in safe lifting practices.

Surgical repair of an umbilical hernia is indicated if there is pain, dysfunction, or enlargement. The surgical approach to umbilical hernia repair is determined by the size of the hernia and other patient-specific factors such as comorbidities, body mass index, and the presence of other abdominal wall hernias. While elective umbilical hernia repair can be performed under local anesthesia with sedation or general anesthesia, urgent surgery often requires general anesthesia.