A Lump at the Belly Button After Gallbladder Surgery: Port-Site Hernias Explained

A port-site hernia is a bulge at one of the keyhole cuts, usually the one at the belly button, where the muscle layer underneath has not fully knitted back together, so fatty tissue or occasionally bowel can push through; it affects a minority of people after keyhole gallbladder removal, often appears weeks or months later, and is usually repaired with a short planned operation. Most lumps that people notice by their navel after surgery are worth showing to a doctor, but very few are emergencies, and knowing the difference is the point of this page¹.

My own belly button cut was the slowest to settle and the one I worried about most, though in the end it healed flat. I am writing this because a reader messaged me eight months after her operation, having found a soft lump in her navel while doing up her jeans, and could find nothing that told her whether she had a hernia, a lump of scar tissue, or something worse. Every figure below has been checked by a consultant general surgeon.

What a port-site hernia is

It is an incisional hernia at one of the small cuts (ports) used for keyhole surgery, most often at the belly button, where the largest port sits.

Keyhole gallbladder removal is done through three or four small cuts, each about 0.5 to 1 cm, with the gallbladder usually taken out through one of the larger ones². The skin closes neatly, but beneath it the firm layer of the abdominal wall (the fascia) also has to heal. Where that layer does not fully close or later gives way, the inside of the tummy can push through the gap, forming a hernia. Studies consistently find these hernias mostly at the belly button, where the 10 mm or larger port sits and where the gallbladder is often removed³.

The NHS describes a hernia as a bulge or lump that can get bigger when you cough or strain, with the skin over it sometimes looking tight and stretched⁴. After gallbladder surgery that typically means a soft swelling at or just beside the navel scar, more obvious when standing and sometimes disappearing when lying flat. The scars themselves, and how they should look as they heal, are covered in gallbladder surgery scars.

How common it is

Estimates range widely, from well under 1% to several per cent needing repair, and higher when scans are used to look for small hernias.

The spread is not a contradiction so much as a measure of how hard each study looked. A series of 2,930 keyhole gallbladder operations in two Jordanian hospitals found six port-site hernias, an incidence of 0.20%, mostly at the belly button after 10 mm ports³. Two Dutch hospitals reviewing 2,377 operations found 2.1% needed a hernia repair¹. A US study that reviewed CT scans in a subgroup of 545 patients followed for a median of 1.5 years found a hernia on imaging in 16%, far higher than the series that count only hernias needing repair, and introduced its findings by noting that port-site hernias affect 1 to 10% of people after keyhole gallbladder removal⁵.

So the honest answer is that most people never get one, a small minority develop a hernia that needs repairing, and a larger number may have a small gap that never causes trouble. The site’s overview of cholecystectomy risks and complications puts this alongside the other risks of the operation.

Who is more likely to get one

Risk rises with obesity, diabetes, wound infection, a longer operation, a stretched or enlarged port, removal through the belly button, single-incision surgery, and a pre-existing gap between the stomach muscles.

The Jordanian series identified obesity, female sex and 10 mm ports in the midline as the main factors, and listed diabetes, a lengthy procedure, enlarging the cut to get the gallbladder out, and wound infection as further recognised risks³. Where the gallbladder comes out matters: in the Dutch series, hernias needing repair occurred in 3.2% when it was removed through the belly button, against 0.7% when it came out through the upper (epigastric) port¹.

Two other findings are worth knowing. Single-incision keyhole surgery, which puts every instrument through one larger cut at the navel, had a significantly higher long term hernia rate than standard three-port surgery in a Spanish cohort followed for about five years⁶. And in the US imaging study, people who already had diastasis recti, a separation of the two long stomach muscles common after pregnancy and with weight gain, were about four times as likely to develop a port-site hernia (odds ratio 4.12)⁵.

None of these are things a patient can control on the day, but some are worth raising at the clinic beforehand, especially if you already have a bulge at your navel or a known muscle separation. Questions to ask before gallbladder surgery is a good place to add them.

When it shows up, and what else a lump can be

Port-site hernias usually appear weeks to months after the operation, often once normal activity resumes; a lump in the first days is more often swelling or a fluid collection.

In the early recovery period, the belly button cut is often the slowest to settle, and some firmness or swelling under it is common as it heals; the week-by-week recovery guide shows what is normal when. A collection of fluid under the wound, or a small knot of healing tissue, can also feel like a lump. A hernia tends to behave differently: it bulges more when you cough, lift or stand, and may soften or vanish when you lie down. You cannot reliably tell which is which yourself, and your GP or surgical team can usually tell by examining you, sometimes with an ultrasound or CT scan to confirm.

The reader who wrote to me had exactly the classic pattern: nothing for months, then a soft bulge after she went back to carrying her toddler, which flattened when she lay on the sofa. Her GP confirmed a small hernia at the navel and referred her for a planned repair.

Warning signs that need urgent help

A hernia that turns hard, painful and will not go back, especially with vomiting, a swollen tummy or being unable to pass wind or open your bowels, needs same day medical help.

That combination can mean a piece of bowel is trapped in the gap and its blood supply is at risk, which is called strangulation. The NHS flags pain in or around a hernia, a bloated tummy, feeling or being sick, constipation, and a high temperature or shivering as reasons to get urgent advice⁴. If the pain is severe or getting rapidly worse, go to A&E. A soft, painless lump that goes back on its own is not in this category, but should still be shown to your GP in the following days or weeks.

What repair involves

Treatment is a hernia repair operation, often planned rather than urgent, and sometimes small, symptom-free hernias are watched instead.

The NHS lists surgery as the treatment that actually repairs a hernia, with weight loss helping where relevant⁴. For a port-site hernia that usually means a short operation to close the gap in the abdominal wall, either directly with stitches or reinforced with mesh, depending on its size and the surgeon’s judgement. A small hernia that causes no symptoms is sometimes monitored rather than repaired, a decision that belongs to the surgeon who has examined it.

None of this undoes the gallbladder operation, and a hernia does not mean the original surgery went wrong; it is a recognised, generally fixable complication of any cut through the abdominal wall. If you have a bulge by your navel, the right next step is simply to get it looked at, and the right person to say what it is and what to do about it is a doctor who can examine you, not a page like this one.