Last month, Chen, an elderly man, underwent his first surgery for an umbilical hernia in our hospital. People wonder: What is the role of the belly button? What is an umbilical hernia? Why do people have umbilical hernia? Do umbilical hernias always need surgery? The general surgeons at Xinhua Hospital are here to help clear up the confusion. First of all, let’s get to know the belly button. The belly button is the vestige of a person connected to the mother, located in the middle of the abdominal wall, and is the latest part of the abdominal wall to close during embryonic development. People before birth is in the form of a fetus residing in the mother’s uterus and through the umbilical cord and placenta to achieve the exchange of nutrients and excreta between the fetus and the mother, but the belly button does not have any physiological function after birth. So why do people have umbilical hernias? The upright walking and labor of human beings make them significantly different from animals, but upright walking inevitably leads to an upward shift of the body’s center of gravity and an increase in pressure on the low hanging parts of the body, which leads to the occurrence of some specific diseases, one of which is hernia. What we call “hernia” is also known as “hernia” or “small intestine gas”, which refers to any organ or tissue that leaves its original part and passes through a normal or abnormal part of the body. The hernia that protrudes from the belly button is called umbilical hernia. After birth, the residual umbilical cord atrophies and degenerates, and the muscle layer and ligaments around the umbilical cord then strengthen to cover the umbilical orifice; if the coverage is incomplete or the intra-abdominal pressure increases, the abdominal organs will protrude with the weak orifice, thus forming an umbilical hernia. There are two types of umbilical hernia: infantile umbilical hernia and adult umbilical hernia. Most infantile umbilical hernias are congenital disorders, and some umbilical hernias that can close on their own are called physiological umbilical hernias. It is caused by a small gap in the abdominal wall muscles, and when the intra-abdominal pressure increases, such as when the baby cries, part of the peritoneum protrudes from the umbilical ring. Most unlatched umbilical rings can close on their own by age 3 without surgical intervention. A small number of large umbilical hernias with a basal diameter greater than two centimeters that do not close spontaneously by the age of three years require a pediatric surgery visit and, if necessary, surgical intervention. Adult umbilical hernias are all acquired disorders. They are most commonly seen in obese individuals with weak abdominal walls, middle-aged and older adults and menstruating mothers, or in patients with chronic illnesses with increased intra-abdominal pressure. The main manifestation is a round mass protruding from the umbilicus during standing, coughing and exertion, which disappears when lying down. The edge of the hernia ring can be retrieved after the hernia is retracted, and if there is more omentum and intestine protruding, it may be accompanied by vague pain and abdominal discomfort or a mass in the umbilicus. In adult umbilical hernia, the edge of the hernia ring is tougher, less elastic and non-expandable, with a higher chance of entrapment and strangulation. If the pain is sudden and severe, the abdominal contents are actually stuck in the umbilical ring and emergency surgery is necessary, otherwise it is life-threatening, which is exactly what happened in the case of old man Chen. There are three main types of surgery for umbilical hernia. For emergency surgery in cases such as Chen’s, where there is a combination of intussusception or strangulation, a tensioned suture repair method is usually used. For adult umbilical hernia without incarceration or strangulation, a non-tensile preperitoneal lining with an artificial patch can be used, which is more comfortable for the patient and has a low recurrence rate. For patients with huge umbilical hernia and peritoneal defect, we can use tension-free intraperitoneal lining into artificial patch repair. The Center for Hernia and Abdominal Wall Diseases in the Department of General Surgery of Xinhua Hospital has rich experience and a large number of cases in the treatment of umbilical hernia. Doctors suggest that: umbilical hernia in infants and children should be observed or treated surgically under the guidance of pediatric surgeons; umbilical hernia in adults should be treated surgically as early as possible because there is no possibility of self-healing, so as to avoid the emergence of intussusception and strangulation of abdominal organs that cannot be operated on in an emergency, while umbilical hernia in adults is mostly in elderly patients with other organ diseases. Most adults with umbilical hernia are elderly patients with other organ diseases, which are often life-threatening in case of emergency. Therefore, early surgery is recommended for adults with umbilical hernia to prevent future problems.