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Corbi L, Frediani S, Aloi IP, Bertocchini A, Accinni A, Pardi V, Inserra A. Case Report: The acute appendicitis and incarcerated umbilical hernia: a rare association. Front Pediatr 2024; 12:1334562. [PMID: 38384658 PMCID: PMC10880186 DOI: 10.3389/fped.2024.1334562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction One of the most prevalent congenital wall abnormalities in children, umbilical hernias are often linked to premature or small-for-gestational-age babies. In cases of intestinal malrotation or if the cecum is very movable, generalized peritonitis may facilitate the imprisonment of these hernias. Case report We described a case of a 4-month-old baby who had a prior reducible umbilical hernia with a history of fever, vomiting, poor appetite, and constipation for around 48 h. The patient experienced significant intestinal bloating, vomiting, irreducibility of the umbilical hernia, skin pigmentation, and erythema at the umbilical site within 2 days after hospitalization. When there was no free abdominal air, a direct abdominal x-ray revealed evidence of hydro-gas stasis and various hydro-aerial levels that were pertinent to the ileum. In order to reduce the hernia, the patient had an emergency surgical treatment where the hernia sac was isolated and released from the ileal loop, which was securely attached to a fibrin plate. When the herniary sac was opened, a gangrenous and perforated appendix was found inside. On the seventh postoperative day, the patient was released from the hospital after an uncomplicated postoperative stay. Conclusion Our patient's clinical presentation is similar to that of only one other case report involving a 25-day-old male patient. Our case presented with a variant of the clinical symptoms of the previously described umbilical hernia, which became unfixable and strangulated as a result of appendix inflammation. The appendix was discovered inside the hernia sac during surgery.
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Affiliation(s)
| | - Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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2
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Benítez TM, Kim YJ, Kong L, Wang L, Chung KC. Impact of consensus guideline publication on the timing of elective pediatric umbilical hernia repair. Surgery 2023; 174:1281-1289. [PMID: 37586892 DOI: 10.1016/j.surg.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The American Academy of Pediatrics published consensus guidelines advising observation of asymptomatic umbilical hernias until age 4 or 5, given unnecessary risks of early intervention and substantial practice variation. Yet, the impact of guidelines on early repair (age <4) or if certain groups remain at risk for avoidable intervention is unclear. METHODS This retrospective study used data from children's hospitals participating in the Pediatric Health Information System database. Children aged 17 years and younger who underwent umbilical hernia repair from July 2017 to August 2022 were eligible for inclusion. Children with recurrent hernias, an emergency, or urgent presentation were excluded. An interrupted time series using segmented multivariable logistic regression estimated the association of guideline publication in November 2019 with the odds of guideline-adherent repair (age ≥4) after adjusting for sociodemographic characteristics and hospital-level random effects. RESULTS 16,544 children underwent repair, of which 3,115 (18.8%) were children <4 years old. After adjustment, guideline publication was associated with an immediate increase in guideline-adherent repairs (odds ratio = 1.25 95% confidence interval = 1.05-1.49). The interrupted time series found that each month after publication was associated with a 2% increase in the odds of guideline-adherent repair (odds ratio = 1.02, 95% confidence interval = 1.01-1.03). Children with public insurance were nearly 20% less likely to receive guideline-adherent repair than privately insured children (odds ratio = 0.82, 95% confidence interval = 0.74-0.91). Children in the Midwest had lower odds of guideline-adherent repair (Midwest versus Northeast: odds ratio = 0.45. 95% confidence interval = 0.24-0.84). CONCLUSION Guideline publication was associated with greater odds of guideline-adherent repair, yet public insurance coverage and Midwest location remain significant predictors of early repair against recommendations.
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Affiliation(s)
- Trista M Benítez
- University of Michigan Medical School, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI. https://www.twitter.com/benitez_trista
| | - You J Kim
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI; Rush University Medical College, Chicago, IL. https://www.twitter.com/kim_youj
| | - Lingxuan Kong
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Lu Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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Haskins IN. Hernia Formation: Risk Factors and Biology. Surg Clin North Am 2023; 103:835-846. [PMID: 37709390 DOI: 10.1016/j.suc.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The incidence of ventral hernias in the United States is in increasing. Herein, the author details the etiology of congenital and acquired ventral hernias as well as the risk factors associated with the development of each of these types of ventral hernias.
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Affiliation(s)
- Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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Tonosaki K, Suzuki Y, Yonenaga K, Tomimoto K, Yuzawa K, Oku S, Eto S. Infantile umbilical hernia tape fixation method without compression materials. J Gen Fam Med 2023; 24:223-230. [PMID: 37484134 PMCID: PMC10357089 DOI: 10.1002/jgf2.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Compression therapy using compression material is often used for umbilical hernias in infants; however, there are problems regarding its use, such as appearance and cost. In our hospital, we use the tape fixation method without compression materials. We report the effectiveness of this method, its significance in measuring the degree of hernia bulge before treatment, and parent satisfaction with the treatment. Methods We analyzed 77 cases of umbilical hernias (41 boys and 36 girls, mean age 52.7 ± 18.3 days) that were treated with the tape fixation method at the Department of Pediatrics of our hospital. Hernia size was classified based on the height of the bulge: mild (<1 cm), moderate (1≦ and <3 cm), or severe (>3 cm). Treatment duration was compared between the groups using the Steel-Dwass test. After the treatment, a questionnaire was mailed to the parents to assess the treatment satisfaction. Results Seventy-three patients (94.8%) achieved closure of the hernia orifice, with no excess skin and a well-shaped umbilicus. The duration of treatment was significantly shorter, with the following order: mild (18.5 ± 8.2 days), moderate (25.0 ± 11.9 days), and severe cases (47.8 ± 11.7 days). According to the questionnaire, 97.5% of the parents were satisfied with the treatment. Conclusions Our tape fixation method without compression material achieved a high closure rate and a good shape of the umbilicus. In addition, we noted that the height of the hernia bulge can be used as a guide to estimate the duration of treatment.
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Affiliation(s)
- Kanata Tonosaki
- Department of PediatricsMisawa City HospitalAomoriJapan
- Department of General MedicineTowada City HospitalAomoriJapan
- Department of Eat‐Loss Medicine, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Yuki Suzuki
- Department of PediatricsMisawa City HospitalAomoriJapan
| | - Kazumichi Yonenaga
- Department of General MedicineTowada City HospitalAomoriJapan
- Department of Eat‐Loss Medicine, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | | | | | - Shiori Oku
- Department of PediatricsMisawa City HospitalAomoriJapan
| | - Shuji Eto
- Department of PediatricsMisawa City HospitalAomoriJapan
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Nur NM, Mohamed AN, Abdi AM, Çayören H. Spontaneous rupture of umbilical hernia with evisceration of small bowel in an infant: A case report. Int J Surg Case Rep 2023; 106:108227. [PMID: 37084553 PMCID: PMC10140782 DOI: 10.1016/j.ijscr.2023.108227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Umbilical hernia is a condition that frequently affects children, with the majority resolving spontaneously. The appearance of redness, ulceration, or a sudden increase in the size of the umbilical hernia is indicative of a threatening rupture and suggests the requirement for surgical intervention. We hereby present a case of spontaneous umbilical hernia rupture with bowel evisceration. A PRESENTATION OF THE CASE: a 6-month-old infant was admitted to the hospital due to rupture of the umbilical hernia and intestinal evisceration. Following an assessment, a primary resuscitative approach was applied, including wet dressing of the bowel. A segment of the small bowel loop had a compromised blood supply at the time of the operation, so resection with a hand-sewn anastomosis was performed. No other abnormality was identified intraoperatively, and the abdomen was closed. The baby was discharged after a remarkable recovery. CLINICAL DISCUSSION Umbilical hernia in infants is a common condition and may present with serious complications in less common occurrences, including rupture and intestine evisceration, as in our case. By publishing this case, we hope to raise the awareness of physicians regarding the early detection of such complications and urgent consultation with pediatric surgeons. CONCLUSION It is important for both the parents and the clinicians to be aware of these red flags and to seek immediate consultation from a pediatric surgeon for timely intervention. This will help to lessen the severity of the complications that could otherwise put the infant at a higher risk for morbidity.
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Affiliation(s)
- Nuradin Mohamed Nur
- General surgery Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Turkey.
| | - Abdulkadir Nor Mohamed
- General surgery Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Turkey
| | - Abdishakur Mohamed Abdi
- Pediatric Surgery Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Turkey
| | - Hüseyin Çayören
- General surgery Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Turkey
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He K, Hills-Dunlap JL, Kashtan MA, Riley H, Henry OS, Graham DA, Wynne N, Cramm SL, Rangel SJ. Frequency of Potentially Avoidable Surgical Referrals for Asymptomatic Umbilical Hernias in Children. J Surg Res 2022; 277:290-295. [PMID: 35525211 PMCID: PMC9446374 DOI: 10.1016/j.jss.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The American Association of Pediatrics released guidelines in 2019 recommending delay of surgical referral in children with asymptomatic umbilical hernias until 4-5 y of age. The purpose of this study was to assess contemporary rates of potentially avoidable referrals in this cohort of children, and to assess whether rates have decreased following guideline release. METHODS Retrospective analysis of umbilical hernias referrals evaluated at a single pediatric surgery clinic from October 2014 to August 2021. Potentially avoidable referrals (PAR) were defined as asymptomatic, non-enlarging umbilical hernia referrals in a child 3 y of age or younger without a history of incarceration. Referral indication, disposition following clinic visit, and rates of PAR were compared before and after guideline release. RESULTS A total of 803 umbilical hernia referrals were evaluated, of which 48% were in children 3 y of age or younger at time of evaluation ("early" referrals). 33% of all referrals and 68% of early referrals were categorized as a PAR, and rates were similar before and after guideline release (all referrals: 32% versus 33%, P = 0.94; early referrals: 68% versus 67%, P = 0.94). Of the 333 early referrals who were managed expectantly per guideline recommendations, 2 (0.6%) developed incarceration which was managed with successful reduction and interval repair. CONCLUSIONS One-third of all referrals for umbilical hernia evaluation are potentially avoidable, and this rate did not change following release of American Academy of Pediatrics guidelines. Aligning expectations between surgeons and referring providers through improved education and guideline dissemination may reduce avoidable visits, lost caregiver productivity, and exposure to potentially avoidable surgery.
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Affiliation(s)
- Katherine He
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | | | - Mark A Kashtan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Heather Riley
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Owen S Henry
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Dionne A Graham
- Boston Children's Hospital, Center for Applied Pediatric Quality Analytics, Boston, Massachusetts
| | - Nicole Wynne
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Shannon L Cramm
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.
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A Dual-Institutional Study on First Year Practice Outcomes of Pediatric Surgeons Who Trained in the Era of Work Hour Restrictions. Pediatr Surg Int 2022; 38:277-283. [PMID: 34709434 PMCID: PMC8742777 DOI: 10.1007/s00383-021-05037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In July 2003, an 80-h work week restriction for residencies was mandated. This was met with skepticism regarding its potential impact on operative training. We hypothesized no difference in outcomes for pediatric surgeons who trained under duty hour restrictions compared to historical complication rates. METHODS Dual-institutional review of pediatric patients who underwent five of the most common operations (2013-2018) by first-year pediatric surgeons who trained under duty hour restrictions was performed. Tests of proportions were used to compare complication rates to published rates on data collected prior to 2003. RESULTS Patient mean age was 10.1 years. No significant differences (p values > 0.05) were found in laparoscopic appendectomy rates of infection, bleeding or intra-abdominal abscess compared to previously published rates. Pyloromyotomy rates of infection or duodenal perforation were not different. No differences were detected in rates of infection, recurrence or testicular atrophy for inguinal hernia repair. Umbilical hernia rates of infection, bleeding, and recurrence were also not different. There was no difference in CVC rates of hemopneumothoraces; significantly more bleeding events were detected (1.2% vs. 0.1%; p value = 0.04). CONCLUSION In this study, first-year complication rates of pediatric surgeons who trained under duty hour restrictions were not significantly different when compared to published rates.
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8
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Carter LM, Ruiz-Elizalde A, Gross NL. Umbilical hernia causing ventriculoperitoneal shunt dysfunction: illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21455. [PMID: 36060897 PMCID: PMC9435563 DOI: 10.3171/case21455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND When ventriculoperitoneal (VP) shunts and umbilical hernias coexist in the same patient, unique complications can occur. Typically, these are readily identified problems such as cerebrospinal fluid (CSF) fistulas or entrapment of the peritoneal catheter in the hernia. The authors present cases of two children whose VP shunt dysfunction resolved after repair of their umbilical hernias. OBSERVATIONS The authors present two cases of infant patients with shunted hydrocephalus and umbilical hernias. In both cases, the patients presented with distal shunt malfunctions not due to infection. Their shunt function improved once the umbilical hernia was repaired by pediatric surgery. Neither has required shunt revision since umbilical hernia repair. LESSONS Although there are case reports of VP shunts eroding through the umbilicus, developing CSF fistulas, or becoming trapped inside umbilical hernias, there is no case of VP shunt dysfunction caused by just the presence of an umbilical hernia. The authors suspect that the catheter may intermittently enter and exit the hernia. This may cause intermittent obstruction of the distal catheter, or inflammation in the hernia may occur that limits CSF absorption.
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Affiliation(s)
| | - Alejandro Ruiz-Elizalde
- Division of Pediatric Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
| | - Naina L. Gross
- Warren Clinic Pediatric Neurosurgery, Saint Francis Health System, Tulsa, Oklahoma
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Kaur M, Grandpierre V, Oltean I, Weir A, Nasr A. Predictors of spontaneous resolution of umbilical hernia in children. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000287. [DOI: 10.1136/wjps-2021-000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/02/2021] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe aims were to describe the management of umbilical hernias, to define postoperative complications, and to identify the characteristics of patients that were more likely to have spontaneous resolution of their hernia.MethodsAll patients referred for umbilical hernia at the Children’s Hospital of Eastern Ontario from January 1990 to April 2017 were examined via retrospective chart review. Spontaneous resolution of umbilical hernia was examined using binary logistic regression.ResultsWe included 2621 patients presenting with an umbilical hernia. A total of 1587 (60.5%) patients underwent surgical repair at a median age of 3.6 years (IQR 2.3–5.4). Surgical complications consisted of infection (n=3), bleeding (n=3), hematoma (n=3), and anesthesia-related complications (n=3). For every one-unit increase in defect size, the odds of a spontaneous resolution of the hernia were 5% lower while controlling for prematurity and the presence of comorbidities [adjusted odds ratio (aOR)=0.95; 95% confidence intervel (CI) 0.93 to 0.97]. Premature babies were 80% less likely to experience hernia resolution compared with non-premature babies (aOR=0.20; 95% CI 0.03 to 0.74).ConclusionThe odds of spontaneous resolution were lower for premature babies and were negatively correlated with defect size.
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10
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Epidemiology of abdominal wall and groin hernia repairs in children. Pediatr Surg Int 2021; 37:587-595. [PMID: 33386445 DOI: 10.1007/s00383-020-04808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We sought to estimate the prevalence, incidence, and timing of surgery for elective and non-elective hernia repairs. METHODS We performed a retrospective cohort study, abstracting data on children < 18 years from the 2005-2014 DoD Military Health System Data Repository, which includes > 3 million dependents of U.S. Armed Services members. Our primary outcome was initial hernia repair (inguinal, umbilical, ventral, or femoral), stratified by elective versus non-elective repair and by age. We calculated prevalence, incidence rate, and time from diagnosis to repair. RESULTS 19,398 children underwent hernia repair (12,220 inguinal, 5761 umbilical, 1373 ventral, 44 femoral). Prevalence of non-elective repairs ranged from 6% (umbilical) to 22% (ventral). Incidence rates of elective repairs ranged from 0.03 [95% CI: 0.02-0.04] (femoral) to 8.92 [95% CI: 8.76-9.09] (inguinal) per 10,000 person-years, while incidence rates of non-elective repairs ranged from 0.005 [95% CI: 0.002-0.01] (femoral) to 0.68 [95% CI: 0.64-0.73] (inguinal) per 10,000 person-years. Inguinal (median = 20, interquartile range [IQR] = 0-46 days), ventral (median = 23, IQR = 5-62 days), and femoral hernias (median = 0, IQR = 0-12 days) were repaired more promptly and with less variation than umbilical hernias (median = 66, IQR = 23-422 days). CONCLUSIONS These data describe the burden of hernia repair in the U.S. The large variation in time between diagnosis and repair by hernia type identifies an important area of research to understand mechanisms underlying such heterogeneity and determine the ideal timing for repair. LEVEL OF EVIDENCE Prognosis study II.
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Structure of direct and indirect umbilical hernia and the implication on surgical repair in children. ANNALS OF PEDIATRIC SURGERY 2020. [DOI: 10.1186/s43159-020-00033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Umbilical hernia (UH) is one of the most common problems seen by paediatric surgeons. The recurrence rate after surgical repair is 1–2%. In this study, we examined the ring of umbilical hernia histologically to detect differences between the two types of umbilical hernia and the relation between this histologic difference and the technique of surgical repair.
Results
Fifty paediatric patients of both sexes with clinically diagnosed direct and indirect (oblique) umbilical hernia were collected from the paediatric surgery department in the period between March 2016 and February 2018. Age ranged between 2 and 5 years. Biopsies (5 mm) were taken from the upper, lower, right and left borders of the ring in both types and processed for histological examination. Classification of umbilical hernia was based on Chang-Seok et al.’s classification, which classified the umbilical hernia into three types (direct, oblique and hernia into umbilical cord) which depend on the presence of a hole in the ring and whether the ring is covered by ligamentum teres or not. Histological sections were examined by light microscopy, and data was analysed using chi-square test to detect predominance of one type of collagen fibre over the other in each sample. Transverse collagen fibres were predominant in the upper border of the ring in 15 patients (75%) and the lower border in 14 patients (70%) of direct umbilical hernia. Transverse collagen fibres were also predominant in the right border of the ring in 21 patients (70%) and the left border in 21 patients (70%) of indirect umbilical hernia. This predominance in both cases was found to be statistically significant.
Conclusions
Predominance of transverse collagen fibres in the upper and lower borders of the ring in direct umbilical hernia and predominance in the right and left borders of the ring in oblique umbilical hernia encouraged us to suggest that wound will be more stable if closed in a transverse manner in direct umbilical hernia and a longitudinal manner in oblique umbilical hernia especially in recurrent cases.
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Kepertis C, Tsopozidi M, Anastasiadis K, Godosis D, Demiri C, Spyridakis I. Incarcerated Umbilical Hernia in a 14-Month-Old Female: A Rare Case of Bowel Strangulation. Pediatr Rep 2020; 12:68-71. [PMID: 33114140 PMCID: PMC7717661 DOI: 10.3390/pediatric12030017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022] Open
Abstract
An umbilical hernia, although considered a benign condition of childhood, may rarely manifest with serious complications such as incarceration and viscous organ strangulation. One such case is presented in this report in an attempt to enrich the current literature, due to the relative lack of data in regard to complicated umbilical hernias in children and definite guidelines regarding the monitoring and management of uncomplicated cases. In addition, we discuss some of the latest advancements concerning the matter at issue.
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Nakajima Y, Kondoh S, Yuzuriha S, Yasunaga Y. Umbilical shapes predict future protrusion in pediatric umbilical hernias. Pediatr Int 2020; 62:1162-1170. [PMID: 32359028 DOI: 10.1111/ped.14274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was conducted to evaluate the incidence and early predictive factors of the development of protuberant umbilicus in pediatric umbilical hernia patients. METHODS In this retrospective visual and chart review, patients younger than 3 months with umbilical hernias who initially visited Ina Central Hospital from April 2011 to March 2017 and were followed until they started to walk (at the age of 1 year) were evaluated. The umbilici of the patients at the age of 1 year were classified into two types based on their appearance: concave and protuberant umbilici. Single-factor and logistic regression analyses of the association between the appearance of the umbilicus at the age of 1 year and various clinical data were performed. RESULTS Of the 103 patients, 72% had concave umbilici, and 28% had protuberant umbilici. Single-factor analysis showed significant differences in the umbilical shapes at the initial visit (P < 0.001) and straining habit (P < 0.001). The most ideal logistic regression model demonstrated that umbilici of the highly inflated balloon type (odds ratio, 27.00; 95% confidence interval odds ratio, 5.60-130.08) and crescent type (odds ratio, 14.34; 95% confidence interval odds ratio, 4.22-48.77) were more likely to develop into protuberant umbilici. CONCLUSIONS Umbilical shapes at the initial visit can be used to predict the future development of protuberant umbilici in pediatric patients with umbilical hernias.
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Affiliation(s)
- Yuta Nakajima
- Department of Plastic Surgery, Ina Central Hospital, Ina, Nagano, Japan
| | - Shoji Kondoh
- Department of Plastic Surgery, Ina Central Hospital, Ina, Nagano, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Hills-Dunlap JL, Melvin P, Graham DA, Anandalwar SP, Kashtan MA, Rangel SJ. Variation in surgical management of asymptomatic umbilical hernia at freestanding children's hospitals. J Pediatr Surg 2020; 55:1324-1329. [PMID: 31255325 DOI: 10.1016/j.jpedsurg.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/01/2019] [Accepted: 06/08/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine hospital-level variation in the timing of asymptomatic umbilical hernia repair in children. METHODS Retrospective analysis of children undergoing umbilical hernia repair at 38 children's hospitals using the Pediatric Health Information System database (01/2013-12/2017). Early repair was defined as surgery performed at 3 years of age or younger. Repairs were categorized as emergent/urgent if associated with diagnostic or procedural codes indicating obstruction or strangulation, or if they occurred within 2 weeks of an emergency department encounter. Multivariable regression was used to calculate hospital-level observed-to-expected (O/E) ratios for early repair adjusting for emergent/urgent repair and patient characteristics. RESULTS 23,144 children were included, of which 30% underwent early repair (hospital range: 6.9%-54.3%, p ≪ 0.001). Overall, 3.8% of all repairs were emergent/urgent, and higher rates of early repair did not correlate with higher rates of emergent/urgent repair across hospitals (r = -0.10). Following adjustment, hospital-level O/E ratios for early repair varied 8.9-fold (0.19-1.70, p ≪ 0.001). CONCLUSION Timing of asymptomatic umbilical hernia repair varies widely across children's hospitals, and the magnitude of this variation cannot be explained by differences in patient characteristics or the acuity of repair. Many children may be undergoing repair of hernias that may spontaneously close with further observation. LEVEL OF EVIDENCE Level III (retrospective comparative study).
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Affiliation(s)
- Jonathan L Hills-Dunlap
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Patrice Melvin
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, USA.
| | - Dionne A Graham
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, USA.
| | - Seema P Anandalwar
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mark A Kashtan
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Halleran DR, Minneci PC, Cooper JN. Association between Age and Umbilical Hernia Repair Outcomes in Children: A Multistate Population-Based Cohort Study. J Pediatr 2020; 217:125-130.e4. [PMID: 31711762 DOI: 10.1016/j.jpeds.2019.10.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/17/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate whether patient age or other sociodemographic and clinical characteristics are associated with recurrence or unplanned related hospital revisits after pediatric umbilical hernia repair. STUDY DESIGN We performed a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases of 7 states. Pediatric umbilical hernia repairs performed at any hospital or surgery center in 2010-2014 were included. Hernia recurrences and occurrences of unplanned and related hospital revisits within 30 days were evaluated. RESULTS Of 9809 included patients, 52.0% were female and 50.5% were black. The 3-year hernia recurrence rate was 0.57% (95% CI 0.42, 0.73). In multivariable analysis, the recurrence rate was higher in children <4 years of age than in children 4-10 years of age (hazard ratio [HR] 1.93, 95% CI 1.09, 3.44). Unplanned related hospital revisits within 30 days occurred in 2.5% of patients. Patient characteristics associated with the risk of an unplanned related hospital revisit included age <4 years (HR 2.17, 95% CI 1.70, 2.77) or >10 years (HR 2.11, 95% CI 1.46, 3.05), public insurance (HR 2.10, 95% CI 1.58, 2.79), asthma (HR 1.74, 95% CI 1.32, 2.29), and initial presentation to the emergency department (HR 2.46, 95% CI 1.08, 5.61). CONCLUSIONS Rates of recurrence and unplanned related hospital revisits following pediatric umbilical hernia repair are higher in children younger than 4 years of age. These findings support delaying the repair of asymptomatic umbilical hernia in children until 4 years of age.
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Affiliation(s)
- Devin R Halleran
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH; Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH.
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A Novel Cost-Effective Technique for Speedy Resolution of Infantile Umbilical Hernia: Ammannaya's Technique. Case Rep Surg 2019; 2019:3806358. [PMID: 31583155 PMCID: PMC6754893 DOI: 10.1155/2019/3806358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/21/2019] [Accepted: 08/30/2019] [Indexed: 12/01/2022] Open
Abstract
Umbilical hernia in the infant is common and resolves in majority of the cases by 6 years of age. Observation till this age and surgery in the event of persistence are the widely followed management strategies. Trusses, taping, and adhesive strapping have been tried to achieve speedy resolution with variable success and a significant incidence of skin complications. We present a novel, simple, easily reproducible, and highly cost-effective technique to achieve complete resolution of infantile umbilical hernia in a span of 8 weeks, with no skin complications.
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A new umbilicoplasty technique for the management of large umbilical hernia in children. Hernia 2019; 23:1261-1266. [PMID: 31065913 DOI: 10.1007/s10029-019-01963-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The ideal technique for reconstruction of proboscoid umbilical hernia in children is the subject of ongoing researches. The aim of this study is to describe our umbilicoplasty technique in the surgical repair of proboscoid umbilical hernia and report its results. METHODS The study included 21 children presented with a proboscoid umbilical hernia from 2014 to 2018. All patients had umbilicoplasty by the following technique: skin incisions were marked then a circular incision was made starting near the umbilical scar. We repaired the fascial defects then excised the lateral twin isosceles triangular flaps. A new umbilical depression was created by subcutaneous sutures fixing the center of the umbilical scar to the aponeurosis. We evaluated the results of surgery as excellent, fair or bad based on the criteria of the peripheral rim (raised, flattened or depressed); in addition to the central depression (deep, shallow or absent). RESULTS The study included 12 boys (57%) and the age ranged from 19 to 67 months. The mean duration of the procedure was 45 min and the mean hospital stay was 1 day. All patients had excellent early results and after 12 months follow-up, the umbilicus was naturally looking and had an excellent peripheral rim and a central depression. CONCLUSION The described umbilicoplasty technique in the surgical repair of proboscoid umbilical hernia in children is simple and easy with excellent aesthetic results.
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Zens TJ, Rogers A, Cartmill R, Ostlie D, Muldowney BL, Nichol P, Kohler JE. Age-dependent outcomes in asymptomatic umbilical hernia repair. Pediatr Surg Int 2019; 35:463-468. [PMID: 30430281 DOI: 10.1007/s00383-018-4413-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Umbilical hernias are common in young children. Many resolve spontaneously by age four with very low risk of symptoms or incarceration. Complications associated with surgical repair of asymptomatic umbilical hernias have not been well elucidated. We analyzed data from one hospital to test the hypothesis that repair at younger ages is associated with increased complication rates. METHODS A retrospective chart review of all umbilical hernia repairs performed during 2007-2015 was conducted at a tertiary care children's hospital. Patients undergoing repairs as a single procedure for asymptomatic hernia were evaluated for post-operative complications by age, demographics, and co-morbidities. RESULTS Of 308 umbilical hernia repairs performed, 204 were isolated and asymptomatic. Postoperative complications were more frequent in children < 4 years (12.3%) compared to > 4 years (3.1%, p = 0.034). All respiratory complications (N = 4) and readmissions (N = 1) were in children < 4 years. CONCLUSIONS Age of umbilical hernia repair in children varied widely even within a single institution, demonstrating that timing of repair may be a surgeon-dependent decision. Patients < 4 years were more likely to experience post-operative complications. Umbilical hernias often resolve over time and can safely be monitored with watchful waiting. Formal guidelines are needed to support delayed repair and prevent unnecessary, potentially harmful operations.
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Affiliation(s)
- Tiffany J Zens
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue Madison, Madison, WI, 53792-7375, USA
| | - Andrew Rogers
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue Madison, Madison, WI, 53792-7375, USA
| | - Randi Cartmill
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue Madison, Madison, WI, 53792-7375, USA
| | - Daniel Ostlie
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Bridget L Muldowney
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Peter Nichol
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue Madison, Madison, WI, 53792-7375, USA
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue Madison, Madison, WI, 53792-7375, USA.
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Zens TJ, Cartmill R, Muldowney BL, Fernandes-Taylor S, Nichol P, Kohler JE. Practice Variation in Umbilical Hernia Repair Demonstrates a Need for Best Practice Guidelines. J Pediatr 2019; 206:172-177. [PMID: 30448274 PMCID: PMC6389373 DOI: 10.1016/j.jpeds.2018.10.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/08/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate and better understand variations in practice patterns, we analyzed ambulatory surgery claims data from 3 demographically diverse states to assess the relationship between age at umbilical hernia repair and patient, hospital, and geographic characteristics. STUDY DESIGN We performed a cross-sectional descriptive study of uncomplicated hernia repairs performed as a single procedure in 2012-2014, using the State Ambulatory Surgery and Services Database for Wisconsin, New York, and Florida. Age and demographic characteristics of umbilical hernia repair patients are described. RESULTS The State Ambulatory Surgery and Services Database analysis included 6551 patients. Across 3 states, 8.2% of hernia repairs were performed in children <2 years, 18.7% in children age 2-3 years, and 73.0% in children age ≥4 years, but there was significant variability (P < .001) in practice patterns by state. In regression analysis, race, Medicaid insurance and rural residence were predictive of early repair, with African American patients less likely to have a repair before age 2 (OR 0.62, P = .046) and rural children (OR 1.53, P = .009) and Medicaid patients (OR 2.01, P < .001) more likely to do so. State of residence predicted early repair even when holding these variables constant. CONCLUSIONS The age of pediatric umbilical hernia repair varies widely. As hernias may resolve over time and can be safely monitored with watchful waiting, formal guidelines are needed to support delayed repair and prevent unnecessary operations.
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Affiliation(s)
- Tiffany J Zens
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Randi Cartmill
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Bridget L Muldowney
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sara Fernandes-Taylor
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Nichol
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Zenitani M, Sasaki T, Tanaka N, Oue T. Umbilical appearance and patient/parent satisfaction over 5years of follow-up after umbilical hernia repair in children. J Pediatr Surg 2018. [PMID: 28629819 DOI: 10.1016/j.jpedsurg.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE We evaluated the long-term umbilical appearance and patient/parent satisfaction at follow-up after umbilical hernia repair (UHR). METHODS In a retrospective review of 128 children who underwent UHR and were followed up for over 5 years, satisfaction was assessed using e-mailed questionnaires and attached photographs of the umbilicus. RESULTS The survey response rate was 80.3% by parents, 79.5% by patients, and 72.1% using photographs. The median follow-up period was 7.6 (range, 5.3-10.1) years. The satisfaction rate was 78.9% among parents and 91.5% among patients; however, eight patients (8.5%) reported dissatisfaction with the results. The main reason for dissatisfaction was the shallow depth of the umbilicus (parents, 10/20; patients, 5/8). During the follow-up period, satisfaction increased in 14 cases (14.7%) and decreased in 10 cases (10.5%). Superior hooding was considered an ideal shape for the umbilicus. Concomitant laparoscopic surgery and higher age at surgery were significantly associated with dissatisfaction in parents (P = 0.045) and patients (P = 0.046), respectively. Large defect size was significantly associated with decreased satisfaction during the follow-up period (P = 0.030). CONCLUSION E-mail surveys are useful for long-term follow-up after UHR. Patients with these above risk factors should receive long-term follow-up with careful attention to patient satisfaction. LEVEL OF EVIDENCE Type of study: prognosis study, level II.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Takashi Sasaki
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Natsumi Tanaka
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
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Yoshida S, Yanai T, Tei E, Sueyoshi R, Koga H, Yamataka A. Incarceration of umbilical hernia in infants. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Zens T, Nichol PF, Cartmill R, Kohler JE. Management of asymptomatic pediatric umbilical hernias: a systematic review. J Pediatr Surg 2017; 52:1723-1731. [PMID: 28778691 DOI: 10.1016/j.jpedsurg.2017.07.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/11/2017] [Accepted: 07/16/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Uncomplicated pediatric umbilical hernias are common and most close spontaneously. No formal practice guidelines exist regarding the optimal timing and indications for repair. The objective of this review is to examine the existing literature on the natural history of pediatric umbilical hernias, known complications of repair and non-operative approaches, and management recommendations. STUDY DESIGN A systematic literature search was performed to identify publications relating to pediatric umbilical hernias. Inclusion criteria comprised studies addressing recommendations for optimal timing of repair, evidence examining complications from hernias not operatively repaired, and research exploring the likelihood of pediatric umbilical hernias to close spontaneously. In addition, the websites of all pediatric hospitals in the United States were examined for recommendations on operative timing. RESULTS A total of 787 manuscripts were reviewed, and 28 met criteria for inclusion in the analysis. Studies examined the likelihood of spontaneous closure based on child's age and size of hernia defect, complications of unrepaired umbilical hernias including incarceration, strangulation and evisceration based on child's age and size of defect, incidence of postoperative complications and current recommendations for timing of repair. In addition, 63 (27.5%) of the United States pediatric hospital websites published a wide range of management recommendations. CONCLUSION Despite the high prevalence of pediatric umbilical hernias, there is a paucity of high quality data to guide management. The literature does suggest that expectant management of asymptomatic hernias until age 4-5years, regardless of size of hernia defect, is both safe and the standard practice of many pediatric hospitals. TYPE OF STUDY Review Article. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Tiffany Zens
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Peter F Nichol
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Randi Cartmill
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
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Abstract
Complications related to general pediatric surgery procedures are a major concern for pediatric surgeons and their patients. Although infrequent, when they occur the consequences can lead to significant morbidity and psychosocial stress. The purpose of this article is to discuss the common complications encountered during several common pediatric general surgery procedures including inguinal hernia repair (open and laparoscopic), umbilical hernia repair, laparoscopic pyloromyotomy, and laparoscopic appendectomy.
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Affiliation(s)
- Maria E Linnaus
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016
| | - Daniel J Ostlie
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016.
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Ireland A, Gollow I, Gera P. Low risk, but not no risk, of umbilical hernia complications requiring acute surgery in childhood. J Paediatr Child Health 2014; 50:291-3. [PMID: 24372946 DOI: 10.1111/jpc.12480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/28/2022]
Abstract
AIMS Umbilical hernias are a common finding in the paediatric community, with a preponderance to affect Afro-Caribbean and premature children. The rate of incarceration varies greatly between populations. Therefore, it is valuable to obtain some Australian data on this topic. METHODS We undertook a retrospective study of the records of all patients who underwent umbilical hernia repair over a 12-year period of between October 1999 and May 2012 at Princess Margaret Hospital. From this group, all patients that had an umbilical hernia repair for reason of acute complication were identified and analysed for age, ethnicity and co-morbidities. RESULTS Between October 1999 and May 2012, 433 umbilical hernias were repaired at Princess Margaret Hospital, five of which were as the direct result of an acutely complicated umbilical hernia. The mean age of hernia repair was 5 years old, and the mean age of acute complication was 5 years old. Out of the patients with acutely complicated umbilical hernia, there were no Afro-Caribbean patients, and one was premature complicated by hyaline membrane disease and broncho-pulmonary dysplasia. CONCLUSIONS Western Australia has an incidence of acutely complicated umbilical hernia requiring operative intervention of 1:3000 to 1:11,000. On an international scale, this is low, and studies with similar incidence do not advocate for immediate repair of all identified umbilical hernias. The authors believe repair should be guided by patient and guardian, but if there is an episode of incarceration, acute repair is advised.
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Affiliation(s)
- Amanda Ireland
- Surgical Services, Princess Margaret Hospital, Perth, Western Australia, Australia
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Omentum in the pediatric umbilical hernia: is it a potential alarm for the appearance of complications? Case Rep Pediatr 2012; 2012:463628. [PMID: 23213589 PMCID: PMC3502821 DOI: 10.1155/2012/463628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 10/17/2012] [Indexed: 11/17/2022] Open
Abstract
Umbilical hernia is a common benign condition which resolves spontaneously during the first five years of life. However, in certain cases there are some characteristics which may be indicative of a different prognostic approach, as they increase the possibility of complications. The two cases of umbilical hernia that we describe here were treated operatively and revealed the presence of strangulated and adhered omentum, respectively. Reflecting on the adhesive properties of the omentum, we hypothesized that this may occur more often than it is believed, especially in those cases that are described as recurrent symptomatic herniations. In such cases, there should be increased alert for the possibility of complications during the period of the conservative expectance for resolution.
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Choi WW, McBride CA, Bourke C, Borzi P, Choo K, Walker R, Nguyen T, Davies M, Donovan T, Cartwright D, Kimble RM. Long-term review of sutureless ward reduction in neonates with gastroschisis in the neonatal unit. J Pediatr Surg 2012; 47:1516-20. [PMID: 22901910 DOI: 10.1016/j.jpedsurg.2012.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/22/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A sutureless ward reduction (SWR) protocol was implemented in the neonatal intensive care unit of a tertiary level hospital in 1999. Although the short-term outcomes associated with SWR have been documented, the long-term outcomes are unknown. METHODS Retrospective data were collected from the medical records of all neonates with gastroschisis from September 1999 to December 2010. Data on their growth and development and the prevalence of any health problems were collected. RESULTS Eighty-eight patients with gastroschisis were managed over an 11 year period. Forty-four of these patients received SWR, with 2 deaths in the neonatal period. In the 42 survivors, 35 patients were reviewed at a median age of 7 years and 10 months (range, 6-134 months; interquartile range, 37-124 months). One patient experienced failure to thrive and developmental delay, and later died of a medical complication. Thirty-two patients (91.4%) developed an umbilical hernia, only 2 of whom required umbilical herniotomy. Four patients (11.4%) developed small bowel obstruction, all within the first year. CONCLUSION Most patients with SWR exhibited normal growth with minimal bowel complications. Despite the high incidence of umbilical hernia, the majority resolved spontaneously and did not require subsequent herniotomy.
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Affiliation(s)
- Wilson W Choi
- School of Medicine, University of Queensland, Herston, Queensland 4006, Australia.
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Zendejas B, Kuchena A, Onkendi EO, Lohse CM, Moir CR, Ishitani MB, Potter DD, Farley DR, Zarroug AE. Fifty-three-year experience with pediatric umbilical hernia repairs. J Pediatr Surg 2011; 46:2151-6. [PMID: 22075348 DOI: 10.1016/j.jpedsurg.2011.06.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 05/18/2011] [Accepted: 06/11/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate the long-term surgical and patient-reported outcomes of pediatric umbilical hernia (UH) repairs. METHODS A retrospective review of all children (<18 years old) who underwent UH repair at Mayo Clinic-Rochester in the last half century was done. Follow-up was obtained by mailed survey. RESULTS From 1956 to 2009, 489 children (boys, 251; girls, 238) underwent a primary UH repair. The mean age was 3.9 years (range, 0.01-17.8 years). Complicated UHs that required emergent repair (n = 34, or 7%) included recurrent incarceration (22), enteric fistula (7), strangulation (4), and evisceration (1). Mean UH size was 1.3 cm (range, 0.2-7.0 cm), varying by operative indication (1.0 cm emergent vs 1.5 cm elective repairs, P = .008) and decade of repair (2.2 cm, 1950s-60s vs 1.3 cm, 1990s-2000s; P = .001). Postoperative morbidity (2%) consisted of superficial wound infection (7), hematoma (3), and seroma (1). With a 66% survey response rate and mean follow-up of 13.0 years (range, 0-53.8 years), 8 (2%) patients experienced a recurrence. Most patients reported satisfaction (90%) with the cosmetic appearance of their umbilicus and are pain free (96%). CONCLUSION Pediatric UH repairs have low morbidity and recurrence rates. Most patients are satisfied and pain free. Importantly, complicated UHs were more likely to be associated with smaller defects; therefore, parental counseling for signs of incarceration is recommended even in small defects.
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Hernies ombilicales étranglées chez l’enfant au Burkina Faso: différences avec les pays développés. ACTA ACUST UNITED AC 2010; 103:100-3. [DOI: 10.1007/s13149-010-0039-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 12/02/2009] [Indexed: 10/19/2022]
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Affiliation(s)
- Jennifer Bevacqua
- Pediatric Emergency Department, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
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30
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Pediatric Surgery. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fall I, Sanou A, Ngom G, Dieng M, Sankalé AA, Ndoye M. Strangulated umbilical hernias in children. Pediatr Surg Int 2006; 22:233-5. [PMID: 16435134 DOI: 10.1007/s00383-006-1634-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2002] [Indexed: 11/30/2022]
Abstract
Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children.
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Affiliation(s)
- I Fall
- Department of Surgery, Division of Pediatric Surgery, A. Le Dantec Hospital, Dakar, Sénégal.
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32
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Abstract
Umbilical hernia is a common problem in children, particularly in Africans, but complications in these hernias are thought to be rare. In a retrospective study of 47 children presenting for umbilical hernia repair in 14 years, 30 had complications. The complications included acute incarceration 15, recurrent incarceration 10 and spontaneous evisceration 5. Of the 15 with acute incarceration, 2 required bowel resection for gangrene, and an abscess formed in the hernia sac in one. The age of patients with acute incarceration was 2 months-8 years (median 5 years). The 10 with recurrent incarceration were aged 1-3 years (median 3 years). Of the 5 with spontaneous evisceration, one had umbilical sepsis and another intestinal obstruction from intussusception. These patients were aged 3-12 weeks (median 7 weeks). All the complications occurred in hernias that were 1.5 cm or more in diameter. The hernias were repaired using standard methods. Postoperatively, 2 patients developed wound infection. There was no mortality. Though complications of umbilical hernias appear to be rare, there is a need for more active observation of these hernias to identify complications early and treat promptly to avoid morbidity.
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Affiliation(s)
- Emmanuel A Ameh
- Paediatric Surgery Unit Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
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Abstract
Introduction Umbilical hernia is a common condition in the pediatric population. Embryology Umbilical hernia is a consequence of incomplete closure or weakness at the umbilical ring, where protrusion of intraabdominal contents may occur. Anatomy Fascia posterior to the canal is thinner creating an area of weakness. Congenital or direct hernia occurs in this area, while herniation in the umbilical canal leads to indirect or acquired hernia. Incidence The incidence of umbilical hernia is 1.9% to l8.5% in white population. Clinical manifestations The great majority of pediatric umbilical hernias are asymptomatic. Incarceration and strangulation are uncommon Rupture of umbilical hernia with resultant evisceration is extremely rare Umbilical hernia may also be the source of intermittent umbilical or abdominal pain. Treatment Treatment options for umbilical hernias range from simple observation to surgical repair. The great majority close spontaneously and observation with periodic follow-up is appropriate in most cases. There are no available data to suggest that strapping improves or accelerates closure. Operation would be recommended for defects greater than 1cm, by the age 3 to 4. Persistence or enlargement of fascial defect during the period of observation are reasons to consider repair, whatever the age. Complications Complications of operative repair of umbilical hernias include those related to anesthesia and local wound infections. Conclusion Umbilical hernia is a common condition among infants and children. In the great majority of cases the natural history is one of eventual closure without treatment. If spontaneous closure does not occur until the age of 3-4 years, operative correction is recommended.
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Affiliation(s)
- Smiljana Marinković
- Mediciniski fakultet, Institut za zdravstvenu zastitu dece i omladine Klinika za decju hirurgiju, Novi Sad.
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Albanese CT. Pediatric Surgery. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ahmed A, Ahmed M, Nmadu PT. Spontaneous rupture of infantile umbilical hernia: report of three cases. ANNALS OF TROPICAL PAEDIATRICS 1998; 18:239-41. [PMID: 9924562 DOI: 10.1080/02724936.1998.11747953] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Three Nigerian infants with spontaneous rupture of an umbilical hernia are described. In two, hernias developed in the neonatal period following umbilical sepsis. Rupture occurred at the ages of 2 and 3 months, respectively, and was probably precipitated by raised intra-abdominal pressure resulting from excessive crying. The third child had a large, ulcerated umbilical hernia which ruptured at 10 months and was precipitated by damage to the overlying skin. The children were treated successfully.
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Affiliation(s)
- A Ahmed
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Abstract
Over a period of 5 years, four cases of incarcerated (one strangulated) umbilical hernia (UH) in children were observed and treated in Saint-Denis, France. In a review of the literature, only 45 descriptions of complicated UHs in children were found worldwide. Incarceration of UHs is considered to be very rare in children, however, it appears to occur more frequently than it is generally believed. Therefore, a more active therapeutic approach is recommended even in smaller hernias, from more than an aesthetic point of view.
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Affiliation(s)
- P Vrsansky
- Service de Chirurgie Pédiatrique, Hôpital Delafontaine, Saint-Denis, France
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Abstract
Inguinal hernia repair is the most common operation performed in infants and children. In this article, the embryology, clinical presentation, and treatment of congenital inguinal hernias and umbilical hernias in children are reviewed. Specific attention is directed to such topics as the incarcerated hernia, hernias in girls, hernia repair in premature infants, and anesthetic considerations.
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Affiliation(s)
- M A Skinner
- Department of Surgery, Indiana University School of Medicine, Indianapolis
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Larson GM, Vandertoll DJ. Approaches to repair of ventral hernia and full-thickness losses of the abdominal wall. Surg Clin North Am 1984; 64:335-49. [PMID: 6233736 DOI: 10.1016/s0039-6109(16)43289-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This article describes the causes, course, and treatment options for surgical repair of umbilical epigastric and incisional hernias. Special attention is paid to the full-thickness abdominal wall defects, which are particularly difficult wounds to close. A method of closure with Marlex mesh, followed by myocutaneous flap coverage, is discussed.
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