Elsevier

Journal of Pediatric Surgery

Volume 46, Issue 11, November 2011, Pages 2151-2156
Journal of Pediatric Surgery

Original article
Fifty-three–year experience with pediatric umbilical hernia repairs,☆☆

https://doi.org/10.1016/j.jpedsurg.2011.06.014Get rights and content

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.

Section snippets

Methods

Approval from the Mayo Clinic Institutional Review Board was obtained for this study. We identified all children younger than 18 years who underwent a primary UH repair at Mayo Clinic in Rochester, Minnesota, from October 1956 to April 2009. Children with confirmed or suspicion for omphalocele or gastroschisis were excluded. A total of 491 children met inclusion criteria. To obtain recent follow-up, a survey was mailed to all of these patients. The survey consisted of a short questionnaire that

Results

From 1956 to 2009, a total of 489 children underwent a primary UH repair at our institution. The male-to-female ratio was 1:1 (boys, 251; girls, 238). Mean age at repair was 3.9 years (range, 0.01-17.8 years). History of prematurity was present in 60 patients (12%), and 108 (22%) had at least 1 significant comorbidity (Table 1). The most common operative indication was size of the hernia defect or persistence of the hernia (46%), followed by repair of the UH in the setting of another surgical

Discussion

This study evaluated the long-term outcomes of UH repairs in children. In congruence with what has been reported previously [2], [7], [8], our data demonstrate that UH repairs in children do indeed have low postoperative morbidity (2%) and recurrence rates (2%) even after a long follow-up period.

Historically, preoperative complications emanating from the UH itself such as incarceration, strangulation, or evisceration are considered to be rare events: approximately 1 in every 1500 hernias [12],

References (21)

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Support and grants: This publication was made possible by grant 1 UL1 RR024150 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

☆☆

Presented at the Pacific Association of Pediatric Surgeons Annual Meeting, April 2011, Cancun, Mexico.

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