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Zeng FT, Seye C, Mbaye PA, Ndoye NA, Gueye D, Wellé IB, Diedhiou Y, Ngom G. Littre's Umbilical Hernia in a Child: A Case Report and Scoping Review. Cureus 2024; 16:e60510. [PMID: 38883105 PMCID: PMC11180487 DOI: 10.7759/cureus.60510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Littre's umbilical hernia (UH) is a rare disease, the third most common Littre hernia. Most case reports interest adult patients. We reported the case of a four-year-old girl with anemia and symptomatic UH, with an incidentally diagnosed Meckel's diverticulum (MD) containing pancreatic ectopic tissue. We reviewed case reports on Littre's umbilical hernia without a date or language restriction. Including our patient, 21 cases were reviewed, of whom 15 (71.4%) were adults and 13 (61.9%) were males. Complicated umbilical hernia occurred in 13 patients (61.9%) and symptomatic MD in two children (9.5%). Investigations preoperatively diagnosed two patients (9.5%). Eighteen patients (85.7%) underwent open surgery, Meckel's diverticulum removal was performed in 18 patients (85.7%), and primary umbilical hernia repair was performed in 16 (76.2%). Ectopic tissue was present in four patients (19.1%), and long-term outcomes were excellent in all patients.
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Affiliation(s)
- Florent T Zeng
- Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, SEN
| | - Cheikh Seye
- Pediatric Surgery, Université Alioune Diop, Diourbel, SEN
| | - Papa A Mbaye
- Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, SEN
| | - Ndèye A Ndoye
- Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, SEN
| | - Doudou Gueye
- Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, SEN
| | - Ibrahima B Wellé
- Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, SEN
| | - Youssouph Diedhiou
- Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, SEN
| | - Gabriel Ngom
- Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, SEN
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Hadj-Youssef S, Rondeau F, Golo KT, Ghali N, Laberge M, Li P, Beltempo M, Lacroix G, Wissanji H. Provincial Review of Adherence to Age-specific Guidelines for Umbilical Hernia Repair and Trends in Management. J Pediatr Surg 2024; 59:791-799. [PMID: 38418272 DOI: 10.1016/j.jpedsurg.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Umbilical hernia (UH) is a common pediatric condition, for which delaying surgical repair for asymptomatic UH until after age 3 is recommended due to a high incidence of spontaneous closure. We aimed to determine the adherence to guidelines, rate of urgent surgical repair, outcomes, cost, and interinstitutional referral patterns of UH repair in the province of Quebec (Canada). METHODS This was a population-based retrospective cohort study of children 28 days to 17 years old who underwent UH repair between 2010 and 2020 using health administrative databases. Children who had multiple procedures, or prolonged peri-operative stays were excluded. Early repair was defined as elective surgery at or under age 3. RESULTS Of the 3215 children, 1744 (54.2%) were female, and 1872 (58.2%) were treated in a tertiary children's hospital. Guidelines were respected for 2853 out of 3215 children (89.7%). Patients living over 75 km from their treating hospitals (OR 2.36, 95% CI 1.33-4.16, P < 0.01), with pre-existing comorbidities (OR, 2.82; 95% CI, 1.96-4.05; P < 0.001), or being treated in a tertiary center (OR 2.10, 95% CI 1.45-3.03, P < 0.001) had a higher risk of early repair. Repair at or under age 3 and urgent surgery were associated with significant cost increases of 411$ (P < 0.001) and 558$ (P < 0.001), respectively. CONCLUSION Quebec has a high rate of adherence to age-specific guidelines for UH repair. Future research should explore factors that explain transfers into tertiary centers, and the extent to which these reflect efficient use of resources. LEVEL OF EVIDENCE level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Shadi Hadj-Youssef
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montréal, QC, Canada
| | - Félix Rondeau
- Department of Economics, Université Laval, Pavillon Charles-De Koninck, 1030 Av. des Sciences Humaines, Québec, QC, Canada
| | - Kossi Thomas Golo
- Ministère de la santé et des services sociaux (MSSS), 1075, chemin Sainte-Foy, Québec City, QC, Canada
| | - Nizar Ghali
- Ministère de la santé et des services sociaux (MSSS), 1075, chemin Sainte-Foy, Québec City, QC, Canada
| | - Maude Laberge
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, QC, Canada; Vitam, Centre de recherche en santé durable-Université Laval, Québec, QC, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Patricia Li
- Division of General Pediatrics, Department of Pediatrics, McGill University Health Centre - Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University Health Centre - Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, Quebec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Pavillon Charles-De Koninck, 1030 Av. des Sciences Humaines, Québec, QC, Canada
| | - Hussein Wissanji
- Harvey E. Beardmore Division of Pediatric Surgery, Department of Pediatric Surgery, McGill University Health Center, Montreal Children's Hospital, Canada.
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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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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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Contemporary practice and perceptions surrounding the management of asymptomatic umbilical hernias in children: A survey of the American Pediatric Surgical Association. J Pediatr Surg 2020; 55:2052-2057. [PMID: 32122639 DOI: 10.1016/j.jpedsurg.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore variation in perceptions regarding the natural history of asymptomatic umbilical hernias, and to characterize the influence of clinical and nonclinical factors on decision-making surrounding timing of repair. METHODS This was a survey of the American Pediatric Surgical Association. Branching logic and Likert scale questions were used to explore perceptions surrounding natural history (risk of complications and likelihood of spontaneous closure), preferred age for repair, and influence of anatomic, caregiver, sociodemographic, and biological factors on operative timing. RESULTS 44% of members completed the survey (371/846). The most common age respondents would consider elective repair was 3 years (37%), although the majority preferred to wait until 4 or 5 years (54%). Most respondents estimated a <1% risk of complications for unrepaired defects, and much greater variability was found in the perceived likelihood of spontaneous closure over time. Decision-making surrounding operative timing was most influenced by anatomic factors (larger defects, proboscoid changes, and interval growth) and parental anxiety surrounding need for emergency surgery, cosmesis, and stigma of parental neglect. CONCLUSION Practice and perceptions surrounding management of asymptomatic umbilical hernias vary widely. More robust epidemiological data are needed to define the likelihood of spontaneous closure in the context of age and physical exam findings. Collaborative efforts between surgeons and referring providers are also needed to optimize management of caregiver anxiety and expectations surrounding need for surgical referral and repair. LEVEL OF EVIDENCE Level V (expert opinion).
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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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The Prevalence and Characteristics of Untreated Hernias in Southwest Cameroon. J Surg Res 2019; 244:181-188. [PMID: 31299434 DOI: 10.1016/j.jss.2019.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/09/2019] [Accepted: 06/07/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hernias are one of the most commonly encountered surgical conditions, and every year, more than 20 million hernia repairs are performed worldwide. The surgical management of hernia, however, is largely neglected as a public health priority in developing countries, despite its cost-effectiveness. To date, the prevalence and impact of hernia have not been formally studied in a community setting in Cameroon. The aim of this study was to determine the prevalence and characteristics of untreated hernia in the Southwest region of Cameroon. METHODS This study was a subanalysis of a cross-sectional community-based survey on injury in Southwest Cameroon. Households were sampled using a three-stage cluster sampling method. Household representatives reported all untreated hernias occurring in the past year. Data on socioeconomic factors, hernia symptoms, including the presence of hernia incarceration, and treatment attempts were collected between January 2017 and March 2017. RESULTS Among 8065 participants, 73 persons reported symptoms of untreated hernia, resulting in an overall prevalence of 7.4 cases per 1000 persons (95% confidence limit 4.98-11.11). Groin hernias were most commonly reported (n = 49, 67.1%) and predominant in young adult males. More than half of persons with untreated hernia (56.7%) reported having symptoms of incarceration, yet 42.1% (n = 16) of these participants did not receive any surgical treatment. Moreover, 21.9% of participants with untreated hernias never presented to formal medical care, primarily because of the high-perceived cost of care. Untreated hernias caused considerable disability, as 21.9% of participants were unable to work because of their symptoms, and 15.1% of households earned less money. CONCLUSIONS Hernia is a significant surgical problem in Southwest Cameroon. Despite over half of those with unrepaired hernias reporting symptoms of incarceration, home treatment and nonsurgical management were common. Costs associated with formal medical services are a major barrier to obtaining consultation and repair. Greater awareness of hernia complications and cost restructuring should be considered to prevent disability and mortality due to hernia.
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Hills-Dunlap JL, Melvin P, Graham DA, Kashtan MA, Anandalwar SP, Rangel SJ. Association of Sociodemographic Factors With Adherence to Age-Specific Guidelines for Asymptomatic Umbilical Hernia Repair in Children. JAMA Pediatr 2019; 173:640-647. [PMID: 31058918 PMCID: PMC6503577 DOI: 10.1001/jamapediatrics.2019.1061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Current guidelines recommend delaying repair of asymptomatic umbilical hernia in children until after age 4 to 5 years to allow for spontaneous closure. OBJECTIVE To examine the association of sociodemographic factors with adherence to age-specific guidelines for asymptomatic umbilical hernia repair in children. DESIGN, SETTING, AND PARTICIPANTS In this multicenter retrospective cohort study, children 17 years and younger who underwent umbilical hernia repair from January 2013 to June 2018 at 47 freestanding children's hospitals participating in the Pediatric Health Information System database were eligible for study inclusion. Children who underwent multiple procedures, repair of recurrent hernias, or had missing sociodemographic data were excluded. EXPOSURES Early umbilical hernia repair was defined as repair at 3 years or younger. Emergent or urgent presentation was defined as repair performed during the same encounter or within 2 weeks of an emergency department visit, respectively. Patients were categorized by sex, race/ethnicity, insurance type, income quintile, and presence of complex chronic conditions. MAIN OUTCOMES AND MEASURES Multivariable mixed-effects logistic regression was used to evaluate the association of sociodemographic factors with the odds of early repair after adjusting for emergent or urgent presentation and hospital-level effects. RESULTS Of the 25 877 included children, 13 817 (53.4%) were female, 14 143 (54.7%) had public insurance, and the median (interquartile range) age was 5.0 (3.0-6.0) years. Following adjustment, increased odds of early repair was associated with public insurance (public vs commercial insurance: odds ratio [OR], 1.46; 95% CI, 1.36-1.56; P < .001), lower income (lowest vs highest income quintile: OR, 1.48; 95% CI, 1.33-1.65; P < .001), and female sex (female vs male sex: OR, 1.20; 95% CI, 1.13-1.27; P < .001). Children with public insurance in the lowest income quintile had 2.2-fold increased odds of early repair compared with children with commercial insurance in the highest income quintile (OR, 2.15; 95% CI, 1.93-2.40; P < .001). Sociodemographic factors were not associated with increased odds of early repair in the subgroup of children who underwent early repair following emergent or urgent presentation. CONCLUSIONS AND RELEVANCE Public insurance, lower income, and female sex are independently associated with repair of asymptomatic umbilical hernias in children earlier than recommended by current guidelines. These children may be at greater risk of undergoing repair of umbilical hernias that may spontaneously close with further observation.
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Affiliation(s)
- Jonathan L. Hills-Dunlap
- Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts,Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patrice Melvin
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Boston, Massachusetts
| | - Dionne A. Graham
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Boston, Massachusetts
| | - Mark A. Kashtan
- Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seema P. Anandalwar
- Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shawn J. Rangel
- Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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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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König TT, Muensterer OJ. Schnappschüsse aus der kinderchirurgischen Sprechstunde – klinische Diagnosen von Kopf bis Fuß. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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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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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James V, Seguin J, Kwan CW. Urachal Cyst Diagnosed by Point-of-care Ultrasound. Clin Pract Cases Emerg Med 2017; 1:374-376. [PMID: 29849381 PMCID: PMC5965218 DOI: 10.5811/cpcem.2017.9.34905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/06/2017] [Accepted: 09/05/2017] [Indexed: 11/11/2022] Open
Abstract
Irreducible umbilical swelling in infants is considered a surgical emergency because a delay in surgical intervention for an incarcerated umbilical hernia can lead to bowel ischemia and necrosis. We report two patients who presented to a pediatric emergency department with history and symptoms of irreducible umbilical mass suggestive of umbilical hernia. Point-of-care ultrasound was used at the bedside to demonstrate the presence of urachal cyst remnants and accurately guided the care of these children.
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Affiliation(s)
- Vigil James
- University of Toronto, The Hospital for Sick Children, Department of Pediatrics, Division of Emergency Medicine, Toronto, Canada
| | - Jade Seguin
- McGill University, The Montreal Children's Hospital, Department of Pediatrics, Division of Emergency Medicine
| | - Charisse W Kwan
- University of Toronto, The Hospital for Sick Children, Department of Pediatrics, Division of Emergency Medicine, Toronto, Canada
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