Management Of Umbilical Hernia Research Articles

Management of Umbilical Hernia in African Children: The Experience of 2146 Cases.

Umbilical hernia (UH) is common in African and African-descent children. In high-income countries (HICs), it is considered benign, which is not the case in Sub-Saharan ones. Through this study, we aimed to share our experience. A descriptive review was conducted from January 01, 2012 to December 31, 2017 at Albert Royer National Children's Hospital Center. Among the 2499 patients, 2146 cases were included in the review. UH had a frequency of 6.5%, with patients having a mean age of 2.6 years, with a male preponderance of 63%. Emergency consultation occurred in 37.1%. The symptomatic hernia was present in 90.9%. The congenital type was found in 96%, a history of painful episodes was reported in 46%, and medical and surgical comorbidities were found in 30.1% and 16.4%, respectively. Multimodal anesthesia was used in 93.1%. A lower umbilical crease incision was made in 83.2%, the sac was not empty in 16.3%, and additional umbilicoplasty was performed in 16.3%. During a 14-month follow-up, a complication occurred in 6.5% and mortality in 0.05%. In our region, the pediatric UH was predominantly symptomatic, with its natural evolution leading to more complications than in HICs. Its management carried acceptable morbidity.

A comparative study of on-lay and preperitoneal mesh repair in the management of umbilical hernia

Background: Umbilical hernias can cause distress to the patients not only because of their complications but also because of the cosmetic angle, therefore this study was undertaken mainly to study the outcomes of preperitoneal mesh repair and on-lay mesh repair in the management of umbilical hernias.Methods: The present study was a prospective, observational and comparative study undertaken in the department of general surgery, who had been operated in Kamineni hospital LB Nagar, Hyderabad, Telangana, during a study period from November-2020 to September-2021.Results: Of 30 patients who underwent on-lay mesh repair, the mean hospital stay was 3.83±1.8 days; wound infection, seroma, hematoma, flap necrosis was seen in 1, 4, 2, 1 respectively and with no recurrence in 6 months follow-up. Of 30 patients who underwent pre-peritoneal mesh repair, the mean hospital stay was 2.13±0.63 days; Wound infection, seroma, hematoma, flap necrosis was seen in 0, 2, 1, 0 respectively and with no recurrence in 6 months follow-up.Conclusions: On-lay mesh repair can be replaced with preperitoneal mesh repair. Overall mesh related complications, including wound infection, seroma, hematoma, flap necrosis is quite rare. Less Hospital stay and low recurrence rate was observed in preperitoneal method. As wound complication increases risk of recurrence, procedures that do not result in formation of de-vascularizing flaps may be recommended.

A Systematic Review of Current Consensus on Timing of Operative Repair Versus Spontaneous Closure for Asymptomatic Umbilical Hernias in Pediatric.

Introduction:Umbilical hernia is a common pediatric disorder that pediatric surgeons are usually asked to manage. Most cases will be closed spontaneously during the first 4-5 years of life. Low number of studies regarding umbilical defects in children does not allow a definitive guideline to be drawn about their natural history, indications and optimal timing for repair. In this systematic review, we evaluated the existing literature where pediatric umbilical hernias are addressed in regards to watchful waiting versus recommendations on timing of operative repair and we compared our institutional results with current literatureAim:The aim of our study is to review and evaluate the current guidelines in management of umbilical hernias in children and to compare the results with our experience in management of umbilical hernia in our institution.Methods:Online literature search for studies that published about umbilical hernias in pediatric using literature’s search of ACP Journal Club, Clinical Evidence, Dynamed, Cochran Controlled Trial Register (1945-2015), UpToDate, and PubMed. We reviewed the recommendations of these studies regarding conservative treatment, rule and time of surgery, complications, and its natural history trend to close spontaneously. We compared the literature results and recommendations to our institutional results. We also conducted a retrospective medical charts review of 520 children aged between 1 month and 14 years presented to our institution for surgical consultation for asymptomatic umbilical hernia between 2007 and 2017. We only included children with umbilical hernia who are less than 14 years old and without other associated disorders.Results:A Total of 7 studies that met the inclusion criteria were reviewed. These studies examined the possibilities of spontaneous closure of hernia defect in pediatric, incidence of complications from watchful waiting and current recommendations for surgery timing. In general, spontaneous resolution were unlikely to be seen beyond the age of 5 years. Our institutional results found that of 442 cases treated conservatively between 2007 and 2017, 85% are closed spontaneously by 1-5 years of age.Conclusion:There is minimal top-notch clinical data guiding pediatric surgeons on management protocols in regards to umbilical hernias in children. Current published studies and our institutional retrospective study recommend that conservative management of asymptomatic, uncomplicated umbilical hernias until age 4-5 years is both safe and practical.

Conservative Treatment versus Elective Repair of Umbilical Hernia in Patients with Liver Cirrhosis and Ascites

Background: management of umbilical hernia in patients with liver cirrhosis remains controversial. The general surgical opinion is that umbilical hernia in patients with liver cirrhosis and ascites has high operative risks and high recurrence rates after elective repair. Conservative treatment, however, can also have severe complications resulting in emergency repair. In these patients such operations carry an even greater risk of complications than compared to elective operations. Objective: Aiming at comparing between conservative treatment and elective repair of umbilical hernia in patients with liver cirrhosis and ascites. Patients and Methods: a randomized prospective interventional study Our series was carried out on 40 consecutive patients at General Surgery department, Al-Azhar University hospital; Bab Elshaeria, Cairo, Egypt in the period from June 2017 till September 2018. The patients were divided into 20 patients (group A) undergo surgical repair and 20 patients (group B) undergo conservative treatment. Mean follow up was 6 months. Results: elective repair of umbilical hernia in patients with liver cirrhosis and ascites had fewer complications than conservative treatment. Conclusion: Our study showed that elective repair of umbilical hernia in cirrhotic and ascetic patients had less complication than conservative treatment.

Conservative Treatment versus Elective Repair of Umbilical Hernia in Patients with Liver Cirrhosis and Ascites

Background: management of umbilical hernia in patients with liver cirrhosis remains controversial. The general surgical opinion is that umbilical hernia in patients with liver cirrhosis and ascites has high operative risks and high recurrence rates after elective repair. Conservative treatment, however, can also have severe complications resulting in emergency repair. In these patients such operations carry an even greater risk of complications than compared to elective operations. Objective: Aiming at comparing between conservative treatment and elective repair of umbilical hernia in patients with liver cirrhosis and ascites. Patients and Methods: a randomized prospective interventional study Our series was carried out on 40 consecutive patients at General Surgery department, Al-Azhar University hospital; Bab Elshaeria, Cairo, Egypt in the period from June 2017 till September 2018. The patients were divided into 20 patients (group A) undergo surgical repair and 20 patients (group B) undergo conservative treatment. Mean follow up was 6 months. Results: elective repair of umbilical hernia in patients with liver cirrhosis and ascites had fewer complications than conservative treatment. Conclusion: Our study showed that elective repair of umbilical hernia in cirrhotic and ascetic patients had less complication than conservative treatment.

Surgical management of umbilical hernia in female crossbred Jersey Heifer: A case report

Surgical management of umbilical hernia in female crossbred Jersey Heifer: A case report

Spontaneous rupture of a congenital umbilical hernia in an infant: a rare complication

Umbilical hernia is not uncommon in children. Most of these hernias close spontaneously as the children grows; they are often remarkably free from complications. Though in no way affecting the accepted principles of management of umbilical hernia, we feel that this case of spontaneous rupture is worth recording. To report a case of spontaneous rupture of a congenital umbilical hernia with evisceration of small intestines in a 45-day-old 3.5 kg female infant. DOI: http://dx.doi.org/10.3329/bjms.v14i1.21574 Bangladesh Journal of Medical Science Vol.14(1) 2015 p.100-102

Management of umbilical hernias in patients with ascites: development of a nomogram to predict mortality

BackgroundThe objective of this study was to develop an easy-to-use nomogram to assist clinicians in predicting patient-specific mortality in this patient population. MethodsAmerican College of Surgeons National Surgical Quality Improvement Program participant use files were used from 2005 to 2011. Multivariable logistic regression was used to model 30-day postoperative mortality in patients with ascites who underwent umbilical hernia repair. ResultsA total of 688 patients with ascites undergoing umbilical hernia repair were included. There were 643 (94%) survivors and 45 (7%) mortalities. A total of 300 (44%) patients were classified as emergent cases. Using logistic regression to predict 30-day mortality, preoperative Model for End-Stage Liver Disease score, albumin, white blood cell count, and platelet count were found to be significant predictors (P < .05) of mortality and were included in our model. ConclusionWe propose a nomogram to enable clinicians to better estimate mortality in patients with ascites undergoing umbilical hernia repair.

Management in patients with liver cirrhosis and an umbilical hernia

Optimal management in patients with umbilical hernias and liver cirrhosis with ascites is still under debate. The objective of this study was to compare the outcome in our series of operative versus conservative treatment of these patients. In the period between 1990 and 2004, 34 patients with an umbilical hernia combined with liver cirrhosis and ascites were identified from our hospital database. In 17 patients, treatment consisted of elective hernia repair, and 13 were managed conservatively. Four patients underwent hernia repair during liver transplantation. Elective hernia repair was successful without complications and recurrence in 12 out of 17 patients. Complications occurred in 3 of these 17 patients, consisting of wound-related problems and recurrence in 4 out 17. Success rate of the initial conservative management was only 23%; hospital admittance for incarcerations occurred in 10 of 13 patients, of which 6 required hernia repair in an emergency setting. Two patients of the initially conservative managed group died from complications of the umbilical hernia. In the 4 patients that underwent hernia correction during liver transplantation, no complications occurred and 1 patient had a recurrence. Conservative management of umbilical hernias in patients with liver cirrhosis and ascites leads to a high rate of incarcerations with subsequent hernia repair in an emergency setting, whereas elective repair can be performed with less morbidity and is therefore advocated.

Management of umbilical hernias in the horse: treatment options and potential complications

Management of umbilical hernias in the horse: treatment options and potential complications

The management of umbilical hernias in infancy and childhood

Umbilical hernia, a common finding in infants and young children, generally is regarded as a benign condition that often disappears spontaneously. Umbilical defects are particularly common in the black population, the incidence having been reported to be as high as 26.6%.1 Premature infants have been observed to have a higher incidence of umbilical hernias (84% in newborns weighing 1000–1500 g) than do infants with a birth weight of over 2500 g (approximately 21%).2Surgical repair of umbilical hernias is frequently postponed and often not performed because complications of the condition are rare and the majority of the defects close within 2 yr; more than 85% close before the child is 6 yr of age.3 Walker4 observed that the diameter of the umbilical ring is the most reliable indication of whether spontaneous closure of the fascial defect will occur. Most umbilical hernias with an internal fascial ring diameter of less than 0.5 cm close spontaneously by the age of 2 yr; however, most hernias with an internal fascial ring diameter greater than 1.0 cm do not close until the patient is 4 yr of age or frequently never.The decision regarding whether or not to repair umbilical defects in infants and young children has varied greatly among surgeons, extending from the view that no umbilical hernia should be repaired to the opposite position that almost all hernias in children beyond the age of 1 yr should be repaired. Haller et al.5 have provided a helpful guideline for selection of patients for operation and recommend that umbilical defects of 1.5 cm or greater diameter should be repaired in girls over the age of 2 yr and in all children over 4 yr of age to prevent the serious complication of incarceration in adulthood.The present study was undertaken to evaluate the current criteria used in selection of infants and young children for repair of umbilical hernias and to document the incidence of complications caused by the hernia in a combined clinical experience from three large teaching hospitals.