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Reappraisal of adhesive strapping as treatment for infantile umbilical hernia
Satohiko Yanagisawa1, Mototoshi Kato1, Takehito Oshio1,2
1Department of Pediatric Surgery, International University of Health and Welfare Hospital, Tochigi, Japan.
Insights
Adhesive strapping significantly speeds umbilical hernia closure in infants compared to observation alone. This method is an effective alternative to surgery, with high closure rates and minimal complications.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Medical Devices
Background:
- Most umbilical hernias resolve spontaneously by age 3-5.
- Surgical repair is typically reserved for persistent cases.
- Adhesive strapping lacks robust evidence and is associated with skin issues.
Purpose of the Study:
- To evaluate umbilical hernia closure using ultrasonography.
- To reassess the effectiveness of adhesive strapping for umbilical hernias.
Main Methods:
- 89 infants with umbilical hernias received adhesive strapping weekly.
- Hernia orifice diameter was ultrasonographically measured bi-weekly.
- Closure speed was compared between strapping and observation groups.
Main Results:
- 91% of infants achieved closure within 2-13 weeks of strapping.
- Mean closure speed was significantly faster with strapping (2.59 mm/week) vs. observation (0.37 mm/week).
- Closure rates were unaffected by hernia diameter, gestational age, or treatment timing; 5.6% experienced skin complications.
Conclusions:
- Adhesive strapping accelerates spontaneous umbilical hernia closure.
- It is an effective alternative to surgery and observation.
- Efficacy is independent of hernia orifice diameter.
Background:
Most umbilical hernias spontaneously close by 3-5 years of age; therefore, surgical repair is considered only in children whose hernias have not closed by this point. At present, adhesive strapping is not the preferred treatment for umbilical hernias because of the lack of supporting evidence regarding its efficacy, and its association with skin complications. This aim of this study was to examine umbilical hernia closure on ultrasonography, and reassess the merits of adhesive strapping.
Methods:
Between January 2013 and December 2014, 89 infants underwent adhesive strapping for umbilical hernia. The strapping was changed once a week. The diameter of the hernia orifice was measured on ultrasonography every 2 weeks until closure. The closure speed (CS) of the hernia orifice was compared between the infants treated with adhesive strapping and those undergoing observation alone. The association between CS and birthweight, gestational age, diameter of the hernia orifice, and timing of treatment (before 12 weeks of age vs between 12 and 26 weeks of age) was also analyzed.
Results:
Closure was achieved after 2-13 weeks of strapping in 81 infants (91%), and the likelihood of closure was not affected by the diameter of the hernia orifice, gestational age, or the timing of treatment. The mean CS of the infants treated with adhesive strapping was significantly faster than that of the infants undergoing observation alone (2.59 vs 0.37 mm/week, P < 0.05). Adhesive strapping was discontinued in five of the 89 infants (5.6%) due to severe skin complications.
Conclusion:
Adhesive strapping promoted early spontaneous umbilical hernia closure compared with observation alone, regardless of the diameter of the hernia orifice. Adhesive strapping is an effective alternative to surgery and observation.
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