Tiffany Zens1, Peter F Nichol1, Randi Cartmill2, Jonathan E Kohler3. 1. 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. 2. Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 3. 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. Electronic address: kohler@surgery.wisc.edu.
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.
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.
Authors: Lindsey L Wolf; Kristin A Sonderman; Nicollette K Kwon; Lindsey B Armstrong; Brent R Weil; Tracey P Koehlmoos; Elena Losina; Robert L Ricca; Christopher B Weldon; Adil H Haider; Samuel E Rice-Townsend Journal: Pediatr Surg Int Date: 2021-01-01 Impact factor: 1.827
Authors: Tiffany J Zens; Randi Cartmill; Bridget L Muldowney; Sara Fernandes-Taylor; Peter Nichol; Jonathan E Kohler Journal: J Pediatr Date: 2018-11-15 Impact factor: 4.406
Authors: Elisabeth Pechriggl; Michael Blumer; R Shane Tubbs; Łukasz Olewnik; Marko Konschake; René Fortélny; Hannes Stofferin; Hanne Rose Honis; Sara Quinones; Eva Maranillo; José Sanudo Journal: Front Surg Date: 2022-07-07