Umbilical Hernias in Children
Introduction
In children, umbilical hernias are the third most common surgical disorder after hydroceles and inguinal hernias. Although umbilical hernias are present in all of us at birth because this defect in the abdominal wall allows the blood supply from the placenta to nourish us through the nine months of pregnancy, the true incidence is one in every five live births. Prematurity and low birth weight also predisposes to umbilical hernia formation.
What are the signs and symptoms?
The most common reason for a child’s referral is the cosmetic appearance. The hernia results in a protrusion at the umbilicus that bulges every time the child cries or strains. There may also be a history of vague abdominal pain or tenderness on pressing the umbilicus.
Difficulty in reducing the contents of the umbilical hernia (incarceration) is rare and other complications such as strangulation are rarer. It is important that your specialist should also examine the paraumbilical areas and the rest of the midline above and below the umbilicus as they can also have areas of weakness.
When should surgery be undertaken?
It is important to realise that most umbilical hernias close naturally before the age of three years. Surgery is therefore very rarely indicated below the age of three years. However if a complication occurs, then surgery may be indicated at an earlier age.
What is the treatment for umbilical hernias in children?
After this age, surgery can be performed on a day-care patient basis using an open technique and repairing the defect with non-absorbable stitches. Meshes are never used in children except under exceptional circumstances. Open surgery is performed through a small cosmetic incision just below the umbilicus.
How long do children take to recover?
Limiting activity in children is difficult, but if the child is of school age then two weeks of avoiding physical education is appropriate. There will not be any stitches to removed as the wound will have been closed with a subcuticular absorbable suture under the skin. Showering and bathing can be performed normally as the wound is covered with a waterproof dressing.