Structure of direct and indirect umbilical hernia and the implication on surgical repair in children (original) (raw)
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Umbilical Hernia: Basic Concepts, Diagnosis and Treatment Options
Zenodo (CERN European Organization for Nuclear Research), 2023
Umbilical Hernias are those ventral type hernias, and can be located within the umbilicus or in its surroundings, according to "The European Hernia Society "classifications, a hernia can be defined as an umbilical hernia when is located 3 cm above and 3cm below the umbilicus. In order to classify hernias, they have to be divided into 3 types: Omphalocele and gastroschisis, infant umbilical hernias and acquired umbilical hernias. The diagnosis of the patients with umbilical hernias must be correlated with the clinic, although these patients generally are asymptomatic and do not display any other complications besides from an esthetic defect. If the clinical diagnosis is very complicated, image studies may be required as an abdominal ultrasound, tomography or a magnetic resonance. The umbilical hernia treatment can be expectant, open surgery or laparoscopic surgery, depending on the characteristics of the affected patient or the umbilical hernia.
East and Central African Journal of Surgery, 2017
Background: This study was aimed at determine the epidemiology, clinical and treatment outcome of childhood umbilical hernia at the University Hospital of Brazzaville. Methods: It was a retrospective study undertaken conducted over a 15 months period from 1 st January 2014 to 31 st March 2015 in the pediatric surgery department of the University Teaching Hospital of Brazzaville. The study population included both male and female children under the age of 15 who underwent surgery for umbilical hernia. The study variables included the demographic and clinical features and management outcome of patients with umbilical hernias. Xi 2 test was used to compare categorical variables. The significance threshold was set for a value of p <0.05. Results: During the period under review, 1152 children were hospitalized, of whom 185 were diagnosed with hernia including 98 (8.5%) who had umbilical hernias, a frequency of 8.5% of all hospitalizations and 53% of hospitalizations for hernias. The sex ratio was 2.3. The average age was 3.8 years (range 1 month to 15 years). Abdominal pain was the most frequent reason for consultation. The neck diameter was less than 1 cm in 51% and greater than 1 cm in 49% of cases. Surgical treatment was done in all our patients. The average hospital stay was 1.5 days. The surgical site infection was the main complication in 6.1% of cases.
Complicated umbilical hernias in children
Pediatric surgery …, 2003
Umbilical hernia is a common problem in children, particularly in Africans, but complications in these hernias are thought to be rare. In a retrospective study of 47 children presenting for umbilical hernia repair in 14 years, 30 had complications. The complications included acute incarceration 15, recurrent incarceration 10 and spontaneous evisceration 5. Of the 15 with acute incarceration, 2 required bowel resection for gangrene, and an abscess formed in the hernia sac in one. The age of patients with acute incarceration was 2 months-8 years (median 5 years). The 10 with recurrent incarceration were aged 1-3 years (median 3 years). Of the 5 with spontaneous evisceration, one had umbilical sepsis and another intestinal obstruction from intussusception. These patients were aged 3-12 weeks (median 7 weeks). All the complications occurred in hernias that were 1.5 cm or more in diameter. The hernias were repaired using standard methods. Postoperatively, 2 patients developed wound infection. There was no mortality. Though complications of umbilical hernias appear to be rare, there is a need for more active observation of these hernias to identify complications early and treat promptly to avoid morbidity.
A Comparitive Study of Open Vs Laparoscopic Repair in Umbilical and Para Umbilical Hernias
IOSR Journals , 2019
Background: The incidence of umbilical hernias has been reported to be as high as 2% in the adult population and comprises 10% of all hernia repairs performed annually.(1) Umbilical hernias in infants are congenital and are common. It is due to leukocyte adhesion molecule deficiency. They close spontaneously in most cases by the age of 2 years. Those that persist after the age of 5 years are frequently repaired surgically. Umbilical hernias in adults are largely acquired. These hernias are more common in women and in patients with conditions that result in increased intra-abdominal pressure, such as pregnancy, obesity, ascites, or chronic abdominal distension. Materials and methods: This study was a prospective observational study, conducted on 156 patients during a period of 19 months, including all the patients of umbilical and paraumbilical hernia operated in RANGARAYA MEDICAL COLLEGE , KAKINADA within the study period. Results: The laparoscopic umbilical / paraumbilical hernia repair is a better alternative to open hernia repair in view of less post-operative pain, surgical site complications, hospital stay and early return to normal activity, preservation of umbilicus, with better cosmetic value even though it requires longer operative time and recurrence rates are almost similar in both the procedures.
A new umbilicoplasty technique for the management of large umbilical hernia in children
hernia, 2019
Background The ideal technique for reconstruction of proboscoid umbilical hernia in children is the subject of ongoing researches. The aim of this study is to describe our umbilicoplasty technique in the surgical repair of proboscoid umbilical hernia and report its results. Methods The study included 21 children presented with a proboscoid umbilical hernia from 2014 to 2018. All patients had umbilicoplasty by the following technique: skin incisions were marked then a circular incision was made starting near the umbilical scar. We repaired the fascial defects then excised the lateral twin isosceles triangular flaps. A new umbilical depression was created by subcutaneous sutures fixing the center of the umbilical scar to the aponeurosis. We evaluated the results of surgery as excellent, fair or bad based on the criteria of the peripheral rim (raised, flattened or depressed); in addition to the central depression (deep, shallow or absent). Results The study included 12 boys (57%) and the age ranged from 19 to 67 months. The mean duration of the procedure was 45 min and the mean hospital stay was 1 day. All patients had excellent early results and after 12 months follow-up, the umbilicus was naturally looking and had an excellent peripheral rim and a central depression. Conclusion The described umbilicoplasty technique in the surgical repair of proboscoid umbilical hernia in children is simple and easy with excellent aesthetic results.
Umbilical Hernia Factors Affecting Outcome
Journal of Evolution of Medical and Dental Sciences, 2016
Aim of this study is to compare the effectiveness of surgical technique-Mesh repair techniques versus anatomical repair techniques with respect to the parameters of complications and recurrence rate. MATERIALS AND METHODS A detailed clinical study of paraumbilical hernia treated with both Mesh repair and Anatomical repair was undertaken at Department of General Surgery from January 2015 to June 2016 at K.R. Hospital attached to Mysore Medical College and Research Institute. Sixty patients were randomly assigned to Group A-Mesh Repair and Group B-Anatomical (Mayo's Repair). The same group of patients were studied for incidence, clinical features, treatment and postoperative complications pertaining to study period. Pts with irreducibility and incarcerated hernia were excluded from the study. Median period of followup was eighteen months. RESULTS Paraumbilical hernia is more common between 3rd and 6th decade of life. It is more common in males 56.7% than in females. There is no difference in age distribution of cases between males and females. Most common presenting symptom is swelling around the umbilicus, which may or may not be associated with pain. Most common position was Supraumbilical (56.7%), post-op complications like wound infection occurred in 10% in mesh repair and 6.67% in anatomical repair. In long-term follow-up, the recurrence was higher in Mayo's suture repair (10%) compared to mesh repair (3.33%) in our studies. CONCLUSION This study concludes that mesh repair has low recurrence rate with minimum complications. Mesh repair is considered the best and more superior to anatomical repair in due consideration to recurrence; however, in certain circumstances anatomical repair holds good which is cheaper and simple procedure.
Current concepts on adult umbilical hernia
Hernia, 1999
Umbilical hernia has not received as much attention as other abdominal wall defects. Prevalence in the adult population is 2% and is much more common in cirrhotic patients and obese middle-aged multiparous women. Adult umbilical hernias have an acquired origin as a consequence of increases in pressure (pregnancy, ascites, etc.), the pull of the abdominal muscles, and the deterioration of connective tissue. Attention needs to be paid to the development of umbilical hernias after laparoscopic trocar insertion. All trocar sites larger than 10 mm should be properly closed after operation. The high morbidity and mortality associated with incarcerated umbilical hernias demand an elective repair in all circumstances. There is a lack of control trials evaluating the results of surgical repairs based on the tight overlapping closure of the umbilical ring described by Mayo, while recurrence after umbilical herniorrhaphy is thought to be a common event. The possibility of the application of biomaterials to the surgical correction of umbilical hernias that have been successfully used in the inguinal canal opens a new field for further clinical investigation. Control studies with long follow-up are now required in order to establish evidence based umbilical surgery.
Laparoscopic versus open surgical treatment of umbilical hernia
Journal of Mind and Medical Sciences
Umbilical hernia is one of the types of ventral hernias of the abdominal wall and it represents the externalization of a part of the abdominal contents through a defect of the anterior abdominal wall located in the umbilical region. It is estimated that more than 20 million abdominal wall hernia surgeries are performed worldwide each year. The paper presents a retrospective study on the patients diagnosed with umbilical hernia and admitted to the First and Second Surgery Departments of the Sibiu County Emergency Clinical Hospital. The study includes 82 cases diagnosed with umbilical hernias over a period of 4 years, between 01.01.2017 and 31.12.2020. Open and laparoscopic surgical techniques are compared in terms of outcomes and postoperative complications. Most cases of umbilical hernia were within the age group 51-70 years, with a slightly higher incidence in males. Arterial hypertension and obesity were the most frequent comorbidities. The alloplastic, classic or laparoscopic pro...