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Age-dependent outcomes in asymptomatic umbilical hernia repair

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Abstract

Purpose

Umbilical hernias are common in young children. Many resolve spontaneously by age four with very low risk of symptoms or incarceration. Complications associated with surgical repair of asymptomatic umbilical hernias have not been well elucidated. We analyzed data from one hospital to test the hypothesis that repair at younger ages is associated with increased complication rates.

Methods

A retrospective chart review of all umbilical hernia repairs performed during 2007–2015 was conducted at a tertiary care children’s hospital. Patients undergoing repairs as a single procedure for asymptomatic hernia were evaluated for post-operative complications by age, demographics, and co-morbidities.

Results

Of 308 umbilical hernia repairs performed, 204 were isolated and asymptomatic. Postoperative complications were more frequent in children < 4 years (12.3%) compared to > 4 years (3.1%, p = 0.034). All respiratory complications (N = 4) and readmissions (N = 1) were in children < 4 years.

Conclusions

Age of umbilical hernia repair in children varied widely even within a single institution, demonstrating that timing of repair may be a surgeon-dependent decision. Patients < 4 years were more likely to experience post-operative complications. Umbilical hernias often resolve over time and can safely be monitored with watchful waiting. Formal guidelines are needed to support delayed repair and prevent unnecessary, potentially harmful operations.

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Abbreviations

ICD-9:

International classification of diseases, ninth revision

CPT:

Current procedural terminology

FDA:

 Food and Drug Administration

ASA:

 American Society of Anesthesiologists

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Acknowledgements

We thank Sara Fernandes-Taylor, PhD, for critical review of the manuscript.

Funding

This research did not receive any grant funding from agencies in the public, commercial, or not-for-profit sectors. It was supported in part by an unrestricted grant from the Cars Curing Kids Foundation.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue Madison, Madison, WI, 53792-7375, USA

    Tiffany J. Zens, Andrew Rogers, Randi Cartmill, Peter Nichol & Jonathan E. Kohler

  2. Division of Pediatric Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Daniel Ostlie

  3. Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Bridget L. Muldowney

Authors
  1. Tiffany J. Zens
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  2. Andrew Rogers
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  3. Randi Cartmill
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  4. Daniel Ostlie
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  5. Bridget L. Muldowney
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  6. Peter Nichol
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  7. Jonathan E. Kohler
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Contributions

JEK, principal investigator, was involved in all aspects of conception and design, data analysis and interpretation, manuscript drafting and revisions, and final manuscript approval. TZ, primary contributor to this project, was involved in all aspects of conception and design, data acquisition, data analysis and interpretation, manuscript drafting and revisions, and final manuscript approval. AR contributed to experimental design, performed a significant component of primary chart review data collection, was integral to data analysis and manuscript writing/revisions, and gave final approval of the manuscript. RC contributed to data analysis, manuscript drafting and revisions, and gave final approval of the manuscript. DO, BM, PN assisted in conception and experimental design, data analysis and interpretation, manuscript drafting and revisions, and gave final approval of the manuscript, providing specific suggestions pertinent to their areas of specialty.

Corresponding author

Correspondence to Jonathan E. Kohler.

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The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Conflict of interest

We have no conflicts of interest to disclose.

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Zens, T.J., Rogers, A., Cartmill, R. et al. Age-dependent outcomes in asymptomatic umbilical hernia repair. Pediatr Surg Int 35, 463–468 (2019). https://doi.org/10.1007/s00383-018-4413-3

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  • DOI: https://doi.org/10.1007/s00383-018-4413-3

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