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Epigastric Hernias in Children: A Personal Series and Systematic Review of the Literature
Georges K Tinawi1, Mark D Stringer1
1Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand.
Insights
Pediatric epigastric hernias are uncommon but can be symptomatic. Standard open repair offers minimal morbidity with no recurrences, while laparoscopic repair provides minor cosmetic benefits.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Abdominal Wall Surgery
Background:
- Epigastric hernias are infrequent in pediatric populations, with limited data on their characteristics and treatment outcomes.
- Existing literature lacks comprehensive analysis of incidence, presentation, natural history, and surgical results for pediatric epigastric hernias.
Purpose of the Study:
- To systematically review the literature on pediatric epigastric hernias.
- To analyze the incidence, presenting features, natural history, and surgical outcomes of both open and laparoscopic repair techniques.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Included studies published between 1975 and 2019, focusing on pediatric epigastric hernias and their surgical interventions.
- Analysis encompassed 8 relevant articles detailing 81 pediatric cases.
Main Results:
- Of 81 children, 58% were female; 35% presented with symptoms, and 8% had multiple hernias.
- All analyzed hernias contained only preperitoneal fat and were treated with open or laparoscopic surgery.
- No recurrences were reported in the reviewed literature or a personal series of 37 hernias.
Conclusions:
- Pediatric epigastric hernias are rare, often asymptomatic, and typically contain only preperitoneal fat.
- Standard open repair is associated with minimal morbidity and excellent outcomes.
- Laparoscopic repair, while offering marginal cosmetic advantages, requires longer operative times.
Abstract:
Epigastric hernias are relatively uncommon in children, and there is a paucity of literature on their incidence, presenting features, natural history, and surgical outcomes. A systematic review was conducted according to PRISMA guidelines. Articles describing the incidence, outcome, and interventions for pediatric epigastric hernias, both open and laparoscopic, were analyzed. Eight relevant articles published between 1975 and 2019 were included in the analysis. Of 81 children, 58% were females, 35% were symptomatic and 8% were multiple. All hernias contained preperitoneal fat only and were repaired using standard open surgery or laparoscopic techniques. No recurrences were recorded. In a personal series of 37 hernias in 36 children of median age 4 years, there were no recurrences; however, this series included two children with a recurrent or persistent epigastric hernia after surgery by others. Epigastric hernias in children are relatively uncommon. They typically contain only preperitoneal fat but more than a third are symptomatic. Standard open repair can be undertaken with minimal morbidity. Laparoscopic repair takes longer and provides a marginal cosmetic benefit.
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