Timing of Surgical Intervention of Uncomplicated Pediatric Umbilical Hernias

Pediatric umbilical hernias are common congenital defects that regularly close without intervention. When spontaneous closure fails to occur, surgical herniorrhaphy is the standard of care. However, there are currently no national consensus guidelines describing the appropriate minimum age of surgical intervention for umbilical hernias. While many institutions recommend waiting until at least 4 years of age, others perform surgical intervention in younger children or base the timing of intervention on defect size. This paper aims to review the current literature and provide a recommendation for the timing of surgical referrals, including evaluating and weighing the risks associated with early operative intervention versus watchful waiting. Complications of untreated umbilical hernias are highly uncommon, with 1:1500 leading to incarceration of abdominal contents, and even fewer resulting in strangulation of the bowel. Comparatively, 12.3% of patients under 4 years old who undergo herniorrhaphy experience postoperative complications. Umbilical hernia repair younger than age 2 years is also associated with higher costs and higher rates of postoperative hospitalization and emergency room encounters. We recommend watchful waiting for uncomplicated pediatric umbilical hernia until 4 years of age and referral to a pediatric surgeon for those that fail to close beyond this.