Umbilical Hernia Repair In Children Research Articles

Long-term cosmetic outcomes of the slit-slide procedure for umbilical hernia repair in children.

To assess the long-term cosmetic outcomes of the "slit-slide procedure", designed to provide a more natural appearance for umbilical hernia repair, as perceived by the patients and their parents. A total of 149 patients with umbilical hernia underwent the slit-slide procedure at our hospital. The slit-slide procedure allows for the creation of an umbilicus with a more natural and integrated appearance. The patient satisfaction survey questionnaire was mailed to the families (n = 139), and there were 74 (53.2%) respondents. A questionnaire survey on postoperative appearance was also distributed to pediatric surgeons. The median age at the time of operation was 2.5years (range, 2months to 14years) and the average median age at the time of answering the questionnaire was 6.25years old (range, 2.5-14.8years). The average median period of observation was 3.2years (range, 4months to 8.97years). Most patients (89.2%) and parents (93.2%) were satisfied with the appearance of the umbilicus. Twenty-seven patients reported improved satisfaction after surgery (36.2%). Surgeons tended to score the elongated-oval shape highly; however, there was no difference in satisfaction among the shapes. The slit-slide procedure is not only effective and safe, but it achieves a satisfactory aesthetic outcome.

Treatment of Patent Processus Vaginalis During Umbilical Hernia Repair in Children

Froehlich, Mary MD; Chang, Shirong MD, FACS; Scheidler, Michael G MD, FACS Author Information

An Unconventional Incision for Umbilical Hernia Repair in Children

An Unconventional Incision for Umbilical Hernia Repair in Children

Safety and Efficacy of a High-Frequency Radio Wave Scalpel for Pediatric Umbilical Hernia Repair

A high-frequency radio wave (HFRW) scalpel has been reported to achieve a fine smooth incision with good hemostasis and minimizes the surrounding tissue destruction. Since an umbilicoplasty was performed for cosmetic purposes, we introduced the HFRW scalpel for umbilical hernia repair in July 2016. This retrospective study aimed to investigate the safety and efficacy of an HFRW scalpel for umbilical hernia repair in children, compared to a surgical scalpel with electrocautery. We reviewed the medical records of 139 patients who underwent umbilical hernia repair using a surgical scalpel with electrocautery or an HFRW scalpel between January 2013 and November 2018. Patients were divided into two groups: the surgical scalpel with electrocautery (SE) group (n = 62) and the HFRW scalpel (HFRW) group (n = 77), for comparison of surgical outcomes. Umbilical hernia repair using the HFRW scalpel was successful without intraoperative complications in all 77 patients. Although the HFRW scalpel was directly used for skin incision, no burn injury was observed. Procedure duration was significantly shorter in the HFRW group than the SE group (P < 0.01). Two (3.2%) and five (6.5%) patients in the SE and HFRW groups, respectively, developed wound infection, which was not a clinically significant difference. Wound appearance in the HFRW group was well tolerated as well as that in the SE group. The HFRW scalpel is a simple, safe, and feasible device for pediatric umbilical hernia repair, with a shorter operative time.

Variation in surgical management of asymptomatic umbilical hernia at freestanding children's hospitals

PurposeTo examine hospital-level variation in the timing of asymptomatic umbilical hernia repair in children. MethodsRetrospective 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. Results23,144 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). ConclusionTiming 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).

Provider education decreases opioid prescribing after pediatric umbilical hernia repair

PurposeTo improve opioid stewardship for umbilical hernia repair in children. MethodsAn educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared. ResultsA total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001) post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18–0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts. ConclusionsOpioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention. Type of StudyRetrospective cohort study. Level of EvidenceLevel II.

Association of Sociodemographic Factors With Adherence to Age-Specific Guidelines for Asymptomatic Umbilical Hernia Repair in Children

Current guidelines recommend delaying repair of asymptomatic umbilical hernia in children until after age 4 to 5 years to allow for spontaneous closure. To examine the association of sociodemographic factors with adherence to age-specific guidelines for asymptomatic umbilical hernia repair in children. 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. 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. 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. 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. 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.

Age-dependent outcomes in asymptomatic umbilical hernia repair.

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. 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. Of 308 umbilical hernia repairs performed, 204 were isolated and asymptomatic. Postoperative complications were more frequent in children < 4years (12.3%) compared to > 4years (3.1%, p = 0.034). All respiratory complications (N = 4) and readmissions (N = 1) were in children < 4years. 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 < 4years 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.

Transumbilical repair of umbilical hernia in children: The covert scar approach

BackgroundUmbilical hernia repairs are one of the most commonly performed operations in children. The traditional repair involves an infraumbilical incision, which produces a visible scar. We report a novel technique of umbilical hernia repair through a transumbilical incision, which eliminates the scar by hiding it within the umbilicus. MethodsWe performed a retrospective chart review of 134 patients who had undergone a transumbilical hernia repair at a single institution between 2008 and 2016. Satisfaction with cosmesis and the presence of complications were assessed through parental interviews during follow up visit or by telephone survey. These data were compared to a large volume retrospective analysis of the standard infraumbilical approach. Results121 of the 134 patients were evaluated in the clinic or by telephone interview. The overall complication rate was 7.44%. Parents of 118 patients reported satisfaction with the cosmetic result (97.52%). In comparison to the largest study of pediatric infraumbilical repair, there was an improvement in subjective cosmesis without a significant increase in complications. ConclusionTransumbilical hernia repair is a safe and cosmetically appealing technique for umbilical hernia repair in children. Level of evidenceTreatment study, level III.

Umbilical appearance and patient/parent satisfaction over 5 years of follow-up after umbilical hernia repair in children

Background/purposeWe evaluated the long-term umbilical appearance and patient/parent satisfaction at follow-up after umbilical hernia repair (UHR). MethodsIn 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. ResultsThe 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). ConclusionE-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 evidenceType of study: prognosis study, level II.

Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial

BackgroundRegional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair. MethodsA single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong–Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay. ResultsFifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35min, p<0.01). Mean postoperative pain scores (PERC-2.6 vs. IO-3.3, p=0.11), morphine equivalents intraoperatively (PERC-0 vs. IO-0.04mg/kg, p=0.29) and postoperatively (PERC-0.04 vs. IO-0.09mg/kg, p=0.17), time to first postoperative narcotic dose (PERC-30 vs. IO-22min, p=0.33, log-rank test), and postoperative length of stay (PERC-76 vs. IO-80min, p=0.44) were similar. ConclusionFollowing umbilical hernia repair in children, percutaneous ultrasound-guided and intraoperative rectus sheath blocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted. Type of studyRandomized controlled trial. Level of evidenceLevel I.

Ultrasound-guided rectus sheath block or wound infiltration in children: a randomized blinded study of analgesia and bupivacaine absorption.

Rectus sheath block can provide analgesia following umbilical hernia repair. However, conflicting reports on its analgesic effectiveness exist. No study has investigated plasma local anesthetic concentration following ultrasound-guided rectus sheath block (USGRSB) in children. Compare the effectiveness and bupivacaine absorption following USGRSB or wound infiltration (WI) for umbilical hernia repair in children. A randomized blinded study comparing WI with USGRSB in 40 children undergoing umbilical hernia repair was performed. Group WI (n = 20) received wound infiltration 1 mg·kg(-1) 0.25% bupivacaine. Group RS (n = 20) received USGRSB 0.5 mg·kg(-1) 0.25% bupivacaine per side in the posterior rectus sheath compartment. Pain scores and rescue analgesia were recorded. Blood samples were drawn at 0, 10, 20, 30, 45, and 60 min. Patients in the WI group had a twofold increased risk of requiring morphine (hazard ratio 2.06, 95% CI 1.01, 4.20, P = 0.05). When required, median time to first morphine dose was longer in the USGRSB group (65.5 min vs. 47.5 min, P = 0.049). Peak plasma bupivacaine concentration was higher following USGRSB than WI (median: 631.9 ng·ml(-1) IQR: 553.9-784.1 vs. 389.7 ng·ml(-1) IQR: 250.5-502.7, P = 0.002). Tmax was longer in the USGRSB group (median 45 min IQR: 30-60 vs. 20 min IQR: 20-45, P = 0.006). USGRSB provides more effective analgesia than WI for umbilical hernia repair. USGRSB with 1 mg·kg(-1) 0.25% bupivacaine is associated with safe plasma bupivacaine concentration that peaks higher and later than WI. Caution against using larger volumes of higher concentration local anesthetic for USGRSB is advised.

Ultrasonography-Guided Bilateral Rectus Sheath Block vs Local Anesthetic Infiltration After Pediatric Umbilical Hernia Repair

Regional anesthetic techniques can be used to alleviate postoperative pain in children undergoing pediatric surgical procedures. Use of ultrasonographic guidance for bilateral rectus sheath block (BRSB) has been shown to improve immediate pain scores and reduce use of postoperative analgesia in the postanesthesia care unit (PACU). To compare efficacy of ultrasonography-guided BRSB and local anesthetic infiltration (LAI) in providing postoperative analgesia after pediatric umbilical hernia repair. Prospective, observer-blinded, randomized clinical trial. Tertiary-referral urban children's hospital. Eligible children 3 to 12 years of age undergoing elective umbilical hernia repair from November 16, 2009, through May 31, 2011. Ropivacaine hydrochloride administered at the conclusion of surgery as LAI by the surgeon (n = 25) or as ultrasonography-guided BRSB by the anesthesiologist (n = 27). Scores on the FACES Pain Rating Scale measured at 10-minute intervals and all use of analgesic medications in the PACU. Median FACES scores in the PACU were lower in the BRSB group compared with the LAI group at 10 minutes (0 vs 1; P = .04), 30 minutes (0 vs 1; P = .01), and 40 minutes or later (0 vs 1; P = .03). Fewer doses of opioid and nonopioid medications were given to the BRSB group compared with the LAI group (5 vs 11 doses for opioids; 5 vs 10 for nonopioids). In the PACU, ultrasonography-guided BRSB after umbilical hernia repair in children is associated with lower median FACES scores and decreased use of opioid and nonopioid medications compared with LAI. Future studies could examine the use of longer-acting anesthetic agents with ultrasonography-guided BRSB. clinicaltrials.gov Identifier: NCT01015053.

Umbilical hernia repair in children: is pressure dressing necessary

The use of pressure dressing to cover the sutured surgical wound is usually considered a routine conclusion to the repair of umbilical hernias in children. The wound is usually left dressed for a minimum of 5-7 days. The main purpose of pressure dressing is prevention of a hematoma formation. The aim of this study was to compare the surgical outcome after umbilical hernia repair in children when the wounds were covered using pressure dressing or left exposed without dressing after the completion of wound closure. Ninety-six patients with umbilical hernia repair were prospectively randomized to receive pressure dressing (n=52) or have their wounds left exposed without any dressing (n=44) after the completion of wound closure. None of the hernias were huge umbilical hernia and none required an umbilicoplasty. In the group who received pressure dressing, one patient developed wound infection 1.9% while no patients developed wound infection in the group who had their wounds exposed without any dressing. In children, there was no significant difference in terms of wound infection, hematoma or seroma formation and recurrence rate after applying pressure dressing or leaving the surgical wounds exposed without any dressing after completion of wound closure. Pressure dressing after umbilical hernia repair may be unnecessary.

Pilot study of rectus sheath block in children

INTRODUCTION Umbilical hernia repair, a common day surgery procedure in children, is associated with significant postoperative discomfort. The rectus sheath block may offer improved pain management following umbilical hernia repair. In this pilot study, we compared the analgesic efficacy of the rectus sheath block with that of infiltration of local anesthetic into the surgical wound (current local standard practice) for pain control after umbilical hernia repair in children.

Management of the sac during umbilical hernia repair in children

The umbilical hernial sac need not be removed completely during umbilical herniorrhaphy in children. This simplifies and shortens the procedure. The use of the pressure dressing as an important adjunct in the postoperative management of these patients is emphasized.