Umbilical Hernia: Open & Robotic Repair

What is an umbilical hernia?

An umbilical hernia happens when tissue from inside your abdomen pushes through a weak spot in the abdominal wall at or near your navel. That tissue might be fat, the lining around your intestines (omentum), or in some cases a loop of intestine itself — creating a visible or feelable bulge.

Types of umbilical hernia

• Reducible — the bulge goes back in when gently pushed.
• Incarcerated — the bulge stays out, even with pressure.
• Strangulated — the blood supply to the trapped tissue is cut off. This is a surgical emergency, and if this is suspected, you'll be sent straight to the Emergency Department.
• Recurrent — a hernia that has been repaired before and has come back.

When is surgery recommended?

Surgery is usually recommended once a hernia causes symptoms, keeps growing, or gets in the way of daily life. The decision about whether mesh is needed depends mainly on the size of the actual defect in your abdominal wall muscle (not how big the bulge looks from outside), your BMI, and whether this is a repeat hernia.

• Defect 2 cm or smaller: a suture-only repair (no mesh) may be appropriate for some patients.
• Defect larger than 2 cm, a recurrent hernia, or a higher BMI: mesh is generally recommended to lower the chance it comes back.
• Profession and activity level also factor in: patients whose work or lifestyle involves heavy lifting or other vigorous activity may be offered mesh even for a smaller defect, since that activity puts more ongoing strain on the repair.

Open vs. robotic repair

Open repair is often used for smaller hernias, made through a single incision at the navel. When mesh is needed in an open repair, it's placed either just outside the abdominal lining or in the space behind the abdominal muscles.

Robotic-assisted repair uses four small incisions placed well off to the side of your navel, giving better spacing and leverage for the instruments. The robotic approach allows mesh to be placed with more overlap around the defect, which can improve durability. Reconstructing a natural-looking, inward navel is part of the plan whenever possible.

How robotic-assisted repair works

During robotic surgery, Dr. Rodriguez sits at a console and controls every instrument movement directly, while the surgical team stays at your side the entire time. The robotic system provides a high-definition, 3D view of the surgical area, allowing precise reconstruction through small incisions.

1. Anesthesia — you're fully asleep for the procedure.
2. Getting in — four small incisions are placed, giving good spacing and mechanical advantage for the instruments. Entry into the abdomen uses a direct-visualization technique (Optiview), chosen specifically to lower the risk of injuring anything underneath as the team enters.
3. Creating the working space — a pre-peritoneal space (just outside the abdominal lining) is created to work in, keeping the repair away from the intestines whenever possible.
4. Closing the defect — the hernia opening in the muscle layer is identified and closed.
5. Placing mesh — if indicated based on defect size, mesh is measured, positioned with generous overlap around the defect, and secured.
6. Reconstructing the navel — careful closure aims to restore a natural, inward-appearing navel whenever possible.

Getting your body ready for surgery

• Quit smoking well before surgery and stay smoke-free during recovery — smoking significantly raises the risk of wound problems, infection, and recurrence.
• Control blood sugar — for patients with diabetes, an A1C under 7% before elective surgery improves healing and lowers infection risk.
• Weight management and control of other chronic conditions may also be part of your prep.

Risks to know about

• Bleeding (usually minor)
• Infection of the incision or, rarely, the mesh
• Injury to intestines, blood vessels, or nerves during initial entry and during the dissection process — this risk is small, but does vary based on anatomy and scar tissue
• Hernia recurrence, even with proper technique
• Chronic pain, fluid collection (seroma), or scarring

Recovery: what to expect

• Wound care: incisions are closed under the skin with dissolvable stitches and a watertight purple surgical glue. You can shower the day of surgery — just pat dry. Do not submerge incisions in a pool, tub, or other body of water for at least 4 weeks. A compression dressing over the navel is usually removed the Sunday after surgery.
• Sun protection: avoid sun exposure on incisions for 6 months to prevent permanent discoloration.
• Pain control: scheduled Tylenol (acetaminophen), Celebrex (celecoxib), and Robaxin (methocarbamol) for the first 3 days, with a narcotic available for breakthrough pain only.
• Activity: walking is encouraged right away. Avoid lifting, pushing, or pulling more than 10–15 pounds for 4 weeks, and avoid core exercises during that time. You can drive again when no longer taking narcotic / sedating medications and you can quickly go from gas to brake pedal without pain inhibiting your movement.