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Ultrasound-Guided Epigastric Hernia Repair in the Pediatric Population: One Institution's Experience and Outcomes
Danielle Dougherty1, Keyonna M Williams1, Darrell Tubbs1
1Section of Pediatric Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA.
Insights
Ultrasound-guided epigastric hernia repair in children is a safe and effective minimally invasive alternative to open surgery. This novel technique offers shorter operative times and can identify concurrent hernias.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Techniques
- Diagnostic Imaging
Background:
- Epigastric hernias are common in pediatric patients.
- Ultrasound is effective for identifying epigastric hernias.
- Traditional open repair is the standard treatment.
Purpose of the Study:
- To describe and assess a novel ultrasound-guided minimally invasive technique for pediatric epigastric hernia repair.
- To compare this technique with traditional open repair.
Main Methods:
- Retrospective chart review of 32 pediatric epigastric hernia repairs (May 2021 - Dec 2022).
- Comparison of 13 ultrasound-guided repairs (prolene suture, no incision) with 19 traditional open repairs.
- Evaluation of operative details and postoperative complications.
Main Results:
- No recurrences or complications in either group.
- Ultrasound-guided repair had a shorter average operative time (24.4 min vs 33.6 min).
- Additional, previously non-apparent epigastric hernias were identified and repaired in 23% of ultrasound cases.
Conclusions:
- Ultrasound-guided epigastric hernia repair is a feasible, safe, and effective alternative for pediatric patients.
- The technique is minimally invasive, has a shorter operative time, and can detect concurrent hernias.
Abstract:
Epigastric hernia repair is a common procedure performed on pediatric patients. These hernias have been demonstrated to be readily identified by ultrasound. This manuscript describes and assesses a novel technique in which ultrasound is used to identify and repair the hernias in a minimally invasive manner. A retrospective chart review evaluates all the ultrasound-guided epigastric hernia repairs done with prolene suture at one institution over 20 months. Operative details and postoperative complications were compared to patients who underwent traditional open epigastric hernia repair at the same institution during the same time frame. Thirty-two pediatric patients underwent epigastric hernia repair between May 2021 and December 2022. Thirteen (41%) underwent the ultrasound-guided technique with prolene suture and using only a meniscus needle and no incision. Nineteen (59%) underwent standard open repair. There were no recurrences or postoperative complications in either group. The average operative time for the ultrasound hernia repair was 24.4 minutes, which was shorter than the average operative time of 33.6 minutes for the open repair (P = .08). In 3 ultrasound cases (23%), an additional epigastric hernia that had not been clinically apparent was identified and simultaneously repaired. Ultrasound-guided epigastria hernia repair is a feasible alternative to traditional open repair. It has a comparable safety and efficacy profile, has a short operative time, and has the advantages of being minimally invasive and having the ability to identify and repair concurrent epigastric hernias.
