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Management of Umbilical Hernia in African Children: The Experience of 2146 Cases
Gabriel Ngom1, Florent Tshibwid A Zeng1, Aloise Sagna1
1Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Cheikh Anta Diop University, Dakar, Senegal.
Insights
Pediatric umbilical hernia (UH) in Sub-Saharan Africa presents differently than in high-income countries, often being symptomatic and leading to more complications. Management showed acceptable morbidity despite these challenges.
Area of Science:
- Pediatric Surgery
- Global Health
- Abdominal Wall Defects
Background:
- Umbilical hernia (UH) is common in African children but differs from benign cases in high-income countries (HICs).
- Sub-Saharan African pediatric UH often presents with symptomatic complications, unlike the typically benign presentation in HICs.
Purpose of the Study:
- To describe the experience and characteristics of pediatric umbilical hernia (UH) management in a Sub-Saharan African setting.
- To compare the presentation and outcomes of pediatric UH in this region with those reported in HICs.
Main Methods:
- A descriptive review of pediatric umbilical hernia cases was conducted.
- Data were collected from January 2012 to December 2017 at Albert Royer National Children's Hospital, including 2146 patients.
Main Results:
- The frequency of UH was 6.5%, with a mean patient age of 2.6 years and a 63% male preponderance.
- 90.9% of cases were symptomatic, 96% were congenital, and 37.1% presented as emergencies.
- Complications occurred in 6.5% of cases during a 14-month follow-up, with a mortality rate of 0.05%.
Conclusions:
- Pediatric umbilical hernia in this region is predominantly symptomatic and evolves with more complications than in HICs.
- The management of pediatric UH in this setting resulted in acceptable morbidity, highlighting the need for region-specific care considerations.
Aims:
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.
Materials And Methods:
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.
Results:
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%.
Conclusion:
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.
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