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JAMA Surgery May 2017Umbilical hernia repair is one of the most commonly performed general surgical procedures. However, there is little consensus about the factors that lead to umbilical...
IMPORTANCE
Umbilical hernia repair is one of the most commonly performed general surgical procedures. However, there is little consensus about the factors that lead to umbilical hernia recurrence.
OBJECTIVE
To better understand the factors associated with long-term umbilical hernia recurrence.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective cohort of 332 military veteran patients who underwent umbilical hernia repair was studied between January 1, 1998, and December 31, 2008, at the VA Boston Healthcare System. Recurrence and mortality outcomes were tracked from that period until June 1, 2014. Data were collected on patient characteristics, operative, and postoperative factors and univariate and multivariable analyses were used to assess which factors were significantly associated with umbilical hernia recurrence and mortality. All patients with primary umbilical hernia repair, with or without a concurrent unrelated procedure, were included in the study. Patients excluded were those who underwent umbilical hernia repair as a part of another major planned procedure with abdominal incisions. Data were collected from June 1, 2014, to November 1, 2015. Statistical analysis was performed from November 2, 2015, to April 1, 2016.
MAIN OUTCOMES AND MEASURES
The primary study outcomes were umbilical hernia recurrence and death.
RESULTS
Of the 332 patients in this study, 321 (96.7%) were male, mean age was 58.4 years, and mean (SD) time of follow-up was 8.5 (4.1) years. The hernia recurrence rate was 6.0% (n = 20) at a mean 3.1 years after index repair (median, 1.0-year; range, 0.33-13 years). The primary suture repair recurrence rate was 9.8% (16 of 163 patients), and the mesh repair recurrence rate was 2.4% (4 of 169 patients). On univariate analysis, ascites (P = .02), liver disease (P = .02), diabetes (P = .04), and primary suture (nonmesh) repairs (P = .04) were significantly associated with increased recurrence rates. Patients who had a history of hernias (125 [39%]) were less likely to have umbilical hernia recurrences (χ21 = 4.65, P = .03). On multivariable regression analysis, obesity and ascites were associated with significantly increased odds ratios of recurrence of 3.3 (95% CI, 1.0-10.1) and 8.0 (95% CI, 1.8-34.4), respectively. Mesh repair was seen to decrease recurrence with odds of 0.28 (95% CI, 0.08-0.95). There was no significant difference in complication rates between mesh repair and primary suture repair. The survival rate was 73% (n = 242) at the end of the study. Factors associated with mortality were older age, smoking, liver disease, ascites, emergency or semiurgent repair, and need for intraoperative bowel resection.
CONCLUSIONS AND RELEVANCE
Ascites, liver disease, diabetes, obesity, and primary suture repair without mesh are associated with increased umbilical hernia recurrence rates. Elective umbilical hernia repair with mesh should be considered in patients with multiple comorbidities given that the use of mesh offers protection from recurrence without major morbidity.
Topics: Adult; Aged; Ascites; Female; Follow-Up Studies; Hernia, Umbilical; Herniorrhaphy; Humans; Male; Middle Aged; Obesity; Recurrence; Retrospective Studies; Risk Factors; Surgical Mesh; Survival Rate; Sutures
PubMed: 28122076
DOI: 10.1001/jamasurg.2016.5052 -
Ultrasound in Obstetrics & Gynecology :... Oct 1995In an ultrasound screening study involving 15,726 viable, singleton pregnancies at 11-14 weeks of gestation, exomphalos was diagnosed in 0.11% of the cases and, in those... (Clinical Trial)
Clinical Trial Review
In an ultrasound screening study involving 15,726 viable, singleton pregnancies at 11-14 weeks of gestation, exomphalos was diagnosed in 0.11% of the cases and, in those with exomphalos, the frequency of trisomy 18, trisomy 13 or triploidy was 61%. The corresponding frequencies of exomphalos of fetuses with these chromosomal defects were 22.5%, 9.1% and 12.5%, respectively. The median maternal age of the screened population was 33 (range 15-48) years, which is higher than in all pregnancies in England and Wales. Expected prevalences of trisomy 18, trisomy 13 and triploidy in the total population were derived on the basis of the age distribution of all deliveries in England and Wales and maternal and gestational age-specific risks for these chromosomal defects. From these numbers and the observed frequencies of exomphalos in association with the various chromosomal defects, it was estimated that the prevalence of exomphalos in a population with the maternal age distribution of all deliveries in England and Wales was 7.4 per 10,000 at 12 weeks of gestation, and this decreased to 3.5 at 20 weeks and 2.9 in live births. The estimated frequency of chromosomal defects in fetuses with exomphalos decreased from 39.4% at 12 weeks of gestation to 27.5% at 20 weeks and 14.4% in live births. The prevalence of chromosomal defects in 153 fetuses with exomphalos referred to our center at 16-26 (median 20) weeks of gestation was not significantly different from that predicted in an unselected population. However, the reported frequency of chromosomal defects in a total of 299 neonates with exomphalos (9.3%) was significantly lower than expected in an unselected population. This study demonstrates that the prevalence of a fetal abnormality and the frequency of associated chromosomal defects depends on the maternal age and gestational age distributions of the populations examined.
Topics: Adult; Chromosomes, Human, Pair 13; Chromosomes, Human, Pair 18; Female; Gestational Age; Hernia, Umbilical; Humans; Maternal Age; Pregnancy; Trisomy; Ultrasonography, Prenatal
PubMed: 8590187
DOI: 10.1046/j.1469-0705.1995.06040250.x -
The Turkish Journal of Pediatrics 2022Mass lesions of the umbilical cord are rare anomalies. There have been rare reports of hemangiomas of the umbilical cord, but the co-occurrence of omphalocele and...
BACKGROUND
Mass lesions of the umbilical cord are rare anomalies. There have been rare reports of hemangiomas of the umbilical cord, but the co-occurrence of omphalocele and hemangioma of the umbilical cord has not been previously reported. Nonetheless, the condition is clinically significant as it may cause the disturbance of intrauterine fetal circulation, retardation of fetal growth and development, non-immune hydrops fetalis, morbidity and mortality.
CASE
Here we aim to report a case that was prenatally diagnosed with an omphalocele and that presented after birth with a hemangioma on the omphalocele sac.
CONCLUSIONS
When dealing with umbilical mass lesions in the prenatal and postnatal periods, a hemangioma on the omphalocele sac should be considered in the differential diagnosis of patients when an omphalocele is suspected.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Hernia, Umbilical; Hemangioma; Umbilical Cord; Hydrops Fetalis; Diagnosis, Differential; Ultrasonography, Prenatal
PubMed: 36305446
DOI: 10.24953/turkjped.2021.5045 -
BMC Pregnancy and Childbirth Apr 2015Little is known about secular trends and seasonal variation in the birth prevalence of omphalocele in China. This study aimed to explore the long-term trends and...
BACKGROUND
Little is known about secular trends and seasonal variation in the birth prevalence of omphalocele in China. This study aimed to explore the long-term trends and seasonality of this birth defect, to provide insight into the etiology and prevention of omphalocele.
METHODS
A retrospective analysis of all births with omphalocele (1322 cases in 8.8 million births) registered in the hospital-based Chinese Birth Defects Monitoring Network between January 1996 and September 2010. Negative binomial cyclical regression models were used to analyze the long-term trends and seasonal fluctuations of omphalocele occurrence in the southern and northern regions and urban and rural areas of China.
RESULTS
The total prevalence of omphalocele was 1.50 cases (95% confidence interval (CI): 1.42-1.58) per 10,000 births. There was no significant secular trend of omphalocele occurrence in China between 1996 and 2010. The observed prevalence of omphalocele in rural areas was 2.03-2.54 cases per 10,000 births between May and August, which was higher than that observed in other months. The highest prevalence of births with omphalocele in rural areas occurred at the end of June; on average, the prevalence of omphalocele at that time point increased by 20% (95% CI: 6-35%) compared with other months.
CONCLUSIONS
There were no long-term trends found for occurrence of omphalocele in China between 1996 and 2010; however, seasonality was observed for omphalocele in women living in rural areas. These results may help generate hypotheses for further study of environmental factors that vary by season.
Topics: China; Congenital Abnormalities; Epidemiological Monitoring; Hernia, Umbilical; Humans; Infant, Newborn; Prevalence; Retrospective Studies; Risk Factors; Rural Population; Seasons
PubMed: 25909955
DOI: 10.1186/s12884-015-0530-3 -
British Medical Journal Apr 1966
Topics: Hernia, Umbilical; Humans
PubMed: 20836216
DOI: 10.1136/bmj.1.5493.981-a -
Genes Jan 2021Hernia is one of the most common defects in pigs. The most prevalent are the scrotal (SH), inguinal (IH) and umbilical (UH) hernias. We compared the inguinal ring...
Hernia is one of the most common defects in pigs. The most prevalent are the scrotal (SH), inguinal (IH) and umbilical (UH) hernias. We compared the inguinal ring transcriptome of normal and SH-affected pigs with the umbilical ring transcriptome of normal and UH-affected pigs to discover genes and pathways involved with the development of both types of hernia. A total of 13,307 transcripts was expressed in the inguinal and 13,302 in the umbilical ring tissues with 94.91% of them present in both tissues. From those, 35 genes were differentially expressed in both groups, participating in 108 biological processes. A total of 67 polymorphisms was identified in the inguinal ring and 76 in the umbilical ring tissue, of which 11 and 14 were novel, respectively. A single nucleotide polymorphism (SNP) with deleterious function was identified in the integrin α M () gene. The microtubule associated protein 1 light chain 3 γ (), vitrin (), aggrecan (), alkaline ceramidase 2 (), potassium calcium-activated channel subfamily M α 1 () and synaptopodin 2 () genes are highlighted as candidates to trigger both types of hernia. We generated the first comparative study of the pig umbilical and inguinal ring transcriptomes, contributing to the understanding of the genetic mechanism involved with these two types of hernia in pigs and probably in other mammals.
Topics: Animals; Biopsy; Chromosome Mapping; Gene Expression Profiling; Gene Regulatory Networks; Genetic Predisposition to Disease; Hernia, Umbilical; Hernia, Ventral; Immunohistochemistry; Male; Polymorphism, Single Nucleotide; Scrotum; Swine; Swine Diseases; Transcriptome
PubMed: 33513662
DOI: 10.3390/genes12020166 -
Chang Gung Medical Journal Jul 200449, XXXXY syndrome is a rare sex chromosomal disorder. A 5-month-old boy had failure to thrive and multiple congenital anomalies including microcephaly, facial... (Comparative Study)
Comparative Study
49, XXXXY syndrome is a rare sex chromosomal disorder. A 5-month-old boy had failure to thrive and multiple congenital anomalies including microcephaly, facial dysmorphism (hypertelorism, megacornea, cleft palate, and micrognathia), obvious heart murmur, umbilical hernia, microphallus, and mild clenched hands. Chromosomal studies via techniques of G-banding and fluorescence in situ hybridization showed the constitution to be 47, XXXXY in all cells. Ventriculomegaly and congenital cardiac defects (patent ductus arteriosus, atrial septal defect, and peripheral pulmonary stenosis) were noted. He has severe atopic dermatitis with high IgE levels and psychomotor retardation. After heart surgery and nutritional support, he has better growth and the rehabilitation program is continuing.
Topics: Abnormalities, Multiple; Chromosomes, Human, X; Face; Hand Deformities, Congenital; Heart Defects, Congenital; Hernia, Umbilical; Humans; In Situ Hybridization, Fluorescence; Infant; Karyotyping; Klinefelter Syndrome; Male; Microcephaly; Sex Chromosome Disorders; Syndrome; Treatment Outcome
PubMed: 15508879
DOI: No ID Found -
Acta Medica Iranica 2012The aim of this article is to present a new Technique of giant omphaloceles repair in neonatal period and also later in life in patients that the primary repair has been...
The aim of this article is to present a new Technique of giant omphaloceles repair in neonatal period and also later in life in patients that the primary repair has been failed. From 1999 to 2006, seven consecutive children (male/female ratio 0.4) with giant omphalocele (n=6) and Gastroschesis (n=2) were underwent this new operation in our center. In this technique, there were two operations. The mean of hospital stay was 38 days (range, 23-42 days), and full enteral feeding was achieved on the 8 to 25 postoperative day (Mean, 14 day). The final closure, in all patients was achieved between the 14 to 32 days after the first operation (Mean, 21 day). Mechanical ventilation was necessary for the mean of 5 days (range, 2-8 days). All patients are alive and have no complication due to the operation (1 month-7 years). Giant omphalocele and Gastroschesis can be safely repaired. The placement of an intraperitoneal tissue expander and traction of abdominal muscles can create the needed space for closure in several weeks in patients with giant omphalocele/ Gastroschesis.
Topics: Adolescent; Child; Child, Preschool; Female; Gastroschisis; Hernia, Umbilical; Humans; Infant; Infant, Newborn; Male; Recurrence; Surgical Procedures, Operative; Tissue Expansion Devices
PubMed: 22837117
DOI: No ID Found -
Arquivos Brasileiros de Cirurgia... 2024Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment.
BACKGROUND
Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment.
AIMS
To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair.
METHODS
A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool.
RESULTS
Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias.
CONCLUSIONS
This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.
Topics: Humans; Herniorrhaphy; Hernia, Umbilical; Randomized Controlled Trials as Topic; Surgical Mesh; Hernia, Abdominal
PubMed: 38896702
DOI: 10.1590/0102-6720202400014e1807 -
Scientific Reports Mar 2018Titanium dioxide nanoparticles (TiO NPs) are among abundantly used metal oxide NPs but their interactions with biomolecules and subsequent embryonic toxicity in higher...
Titanium dioxide nanoparticles (TiO NPs) are among abundantly used metal oxide NPs but their interactions with biomolecules and subsequent embryonic toxicity in higher vertebrates is not extensively reported. Physicochemical interactions of TiO NPs with egg albumen reveals that lower doses of TiO NPs (10 and 25 µg/ml) accounted for higher friccohesity and activation energy but an increment in molecular radii was recorded at higher doses (50 and 100 µg/ml). FTIR analysis revealed conformational changes in secondary structure of egg albumen as a result of electrostratic interactions between egg albumen and TiO NPs. The morphometric data of chicken embryo recorded a reduction at all the doses of TiO NPs, but toxicity and developmental deformity (omphalocele and flexed limbs) were recorded at lower doses only. Inductively coupled plasma optical emission spectrometry (ICP-OES) confirmed presence of Ti in chicken embryos. mRNA levels of genes involved in canonical and non-canonical Wnt signaling were lowered following TiO NPs treatment resulting in free radical mediated disruption of lateral plate mesoderm and somite myogenesis. Conformational changes in egg albumen and subsequent developmental deformity in chicken embryo following TiO NPs treatment warrants detailed studies of NP toxicity at lower doses prior to their biomedical applications.
Topics: Animals; Chick Embryo; Gene Expression Regulation; Hernia, Umbilical; Nanoparticles; Particle Size; Somites; Titanium; Wnt Signaling Pathway
PubMed: 29555972
DOI: 10.1038/s41598-018-23215-7