Fifty-three-year experience with pediatric umbilical hernia repairs
Benjamin Zendejas1, Admire Kuchena, Edwin O Onkendi
1Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Pediatric umbilical hernia (UH) repairs demonstrate excellent long-term results with low complication rates. Most children experience satisfactory cosmetic outcomes and remain pain-free after surgery.
Area of Science:
- Pediatric Surgery
- Hernia Repair
- Surgical Outcomes
Background:
- Umbilical hernia (UH) is a common condition in children.
- Long-term outcomes of pediatric UH repair require further evaluation.
Purpose of the Study:
- To assess the long-term surgical and patient-reported outcomes of pediatric umbilical hernia repairs.
Main Methods:
- Retrospective review of 489 pediatric UH repairs performed over 50 years.
- Follow-up data collected via mailed surveys with a 66% response rate.
Main Results:
- Low postoperative morbidity (2%) and recurrence rate (2%) after a mean follow-up of 13 years.
- High patient satisfaction with cosmetic appearance (90%) and pain-free status (96%).
- Complicated UH repairs were associated with smaller defects, necessitating vigilance for incarceration signs.
Conclusions:
- Pediatric umbilical hernia repair is associated with low morbidity and recurrence.
- The majority of patients report high satisfaction and are pain-free post-surgery.
- Parental counseling on recognizing incarceration signs is crucial, even for small umbilical hernias.
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.
