The approach depends on the patient’s age, hernia size, and complications:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Physical exam: A reducible bulge at the umbilicus that increases with Valsalva maneuver (coughing/strain).
     • Ultrasound or CT scan confirms the diagnosis in complex cases (e.g., incarcerated hernia, obese patients).
     • Blood tests assess fitness for surgery (e.g., hemoglobin, coagulation).
   • Patients are advised to stop smoking and lose weight (if obese) to reduce recurrence risk.
   • Blood thinners (e.g., aspirin) are stopped 5–7 days prior to reduce bleeding risk.
   • Fasting for 6–8 hours before surgery; IV fluids and prophylactic antibiotics (e.g., cefazolin) are given.
2. Surgical Techniques:
   
   • Open Umbilical Hernia Repair:
     
     • Performed under general or local anesthesia (children often under general), lasting 30–60 minutes.
     • A 2–5 cm curved incision is made below or around the umbilicus.
     • The hernia sac is identified, reduced (pushed back), or excised if non-viable.
     • Children: Small defects (<1–2 cm) are closed with sutures (primary repair).
     • Adults: Larger defects (>2 cm) are closed with sutures, and a synthetic mesh (e.g., polypropylene) is often placed to reinforce the area (mesh repair).
     • The incision is closed with absorbable sutures; the navel’s appearance is preserved.
   • Laparoscopic Umbilical Hernia Repair:
     
     • Used for large hernias (>4 cm), recurrent hernias, or in obese patients; performed under general anesthesia, lasting 45–90 minutes.
     • Three small incisions (0.5–1 cm) are made away from the umbilicus (e.g., lateral abdomen).
     • The abdomen is inflated with CO2 gas; a camera and instruments are inserted.
     • The hernia sac is reduced, and a mesh is placed intraperitoneally or preperitoneally to cover the defect.
     • Incisions are closed with glue or sutures; often a day procedure.
   • Emergency Repair:
     
     • For strangulated hernias, an open approach is used; bowel resection may be needed if tissue is non-viable.
3. After Surgery:
   
   • Patients are monitored for a few hours (outpatient) or 1–2 days (emergency or laparoscopic).
   • Pain is managed with analgesics (e.g., paracetamol, ibuprofen); shoulder pain (from CO2) may occur in laparoscopic cases.
   • Antibiotics are rarely needed unless infection or bowel resection occurred.
   • A soft diet starts within 6–12 hours; patients are encouraged to walk early to prevent blood clots.

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