Surgical Repair of umbilical hernia in children

Abstract

Background: Elective repair of an umbilical hernia is one of the most common surgical operations performed by pediatric surgeons, although most of them resolve spontaneously during the first 3 years of life. The exact technique and steps involved in the repair differ widely among pediatric surgeons. Many pediatric surgeons prefer the transverse interrupted suture technique in rectus sheath closure than the purse string or continuous technique as it isolates the tension to each individual stitch, ensures correct suture placement and precise coaptation of edges. It is less likely to devascularize the incision margin. Interrupted sutures also have the advantage that they can be removed individually if infection or haematoma formed, while the purse string suture or the continuous closure has the disadvantage of being a single suture line holding the fascia together and most of wound dehiscence occurs because sutures cut through the fascia. In this study we give a chance to assess the efficacy of the purse string technique. Objective: The aim of our study is to compare between umbilical hernia repair of rectus sheath with closure by interrupted sutures and purse string technique regarding operative time, intra operative complications (bleeding, intestinal injury), and post-operative complications (edema, hematoma formation, seroma formation, cosmetic appearance & recurrence). Materials & Methods: A total of 30 umbilical hernias in children (17 females and 13 males) were operated in Ain Shams University hospital and El Galaa teaching hospital from September 2017 till May 2018. Results: In this prospective study, 30 cases of umbilical hernia in children aging from two years till the age of ten years including 17 female and 13 male with a ratio of 1.3: 1 were randomly selected from the outpatient clinic of Ain Shams University hospital and Al Galaa teaching hospital were divided into two equal groups, group A underwent the repair of the rectal sheath with purse string suture technique while group B underwent the repair with transverse interrupted suture technique. Conclusion: Conclusively, there are no significant differences between both techniques regarding the intra operative complications and post-operative complications in short term follow up; however, transverse interrupted suture technique appears to consume more time than the purse string technique.