From the Guidelines
Umbilical hernias in children should be repaired if they persist beyond age 4-5 years or if they are larger than 1.5-2 cm in diameter, cause pain or discomfort, become incarcerated, or show signs of skin irritation or ulceration, as spontaneous closure becomes less likely after this age and complications can arise 1.
Key Considerations
- The decision for surgical timing should balance the possibility of spontaneous closure against the risk of complications, with the child's overall health status taken into consideration.
- Surgical repair is typically an outpatient surgery with minimal risk, involving a small incision at the umbilicus to close the fascial defect.
- Recovery is usually quick, with most children returning to normal activities within a week.
- Parents should monitor for post-surgical complications such as infection (redness, drainage, fever), but these are uncommon.
Important Factors
- The size of the hernia: larger hernias are less likely to close spontaneously and may require surgical intervention.
- The presence of symptoms: pain, discomfort, incarceration, or skin irritation/ulceration are indications for surgical repair.
- The child's overall health status: children with underlying medical conditions may require more careful consideration and management.
Recommendations
- Surgical repair should be considered in discussion with the patient and a multidisciplinary team involving physicians, surgeons, and anesthetists 1.
- A pediatric surgeon or a general surgeon with experience in pediatric surgery should perform the repair, especially in children 5 years or younger 1.
From the Research
Umbilical Hernia Repair in Children
- The optimal timing for umbilical hernia repair in children is a topic of debate among pediatric surgeons, with some studies suggesting that repair can be delayed until the child is at least 4-5 years old 2, 3, 4.
- Spontaneous closure of umbilical hernias is common in children, with most cases resolving on their own by the age of 4-5 years 2, 3, 5.
- Complications such as incarceration and strangulation are rare, but can occur, especially in younger children 5, 6.
- Studies have shown that children under 4 years of age are more likely to experience post-operative complications and recurrence after umbilical hernia repair 2, 4.
- Delaying repair until the child is at least 4-5 years old may be a safe and practical approach, as it allows for spontaneous closure and reduces the risk of complications 3, 4.
Factors to Consider
- Age: Children under 4 years of age are at higher risk of complications and recurrence after umbilical hernia repair 2, 4.
- Symptoms: Asymptomatic umbilical hernias can be monitored with watchful waiting, while symptomatic hernias may require earlier repair 3.
- Co-morbidities: Presence of co-morbidities such as asthma may increase the risk of complications after umbilical hernia repair 4.