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Pediatrics International : Official... Mar 2021Using a controlled trial, this study aimed to evaluate the effectiveness of adhesive strapping to improve the natural healing rate of umbilical hernia. (Observational Study)
Observational Study
BACKGROUND
Using a controlled trial, this study aimed to evaluate the effectiveness of adhesive strapping to improve the natural healing rate of umbilical hernia.
METHODS
This prospective, observational study included 128 patients from Kumamoto, Japan (97 in the adhesive strapping group, and 31 in observation group), from 2012-2015. The duration from first hospital visit to the hernia orifice closure was compared between the two groups.
RESULT
Kaplan-Meier curves showed that the probability of umbilical hernia in the adhesive strapping group was lower until approximately 200 days, but it was not statistically significant in the log rank test. According to multivariate Cox proportional hazard models, the hazard risk of umbilical hernia in the adhesive strapping group was significantly higher within 0-60 days after adjusting for confounding factors such as hernial cavity and hernia orifice area (P < 0.0001).
CONCLUSION
Adhesive strapping of umbilical hernia was significantly associated with earlier closure of the hernia orifice from baseline until at least 60 days.
Topics: Adhesives; Hernia, Umbilical; Humans; Infant; Japan; Proportional Hazards Models; Prospective Studies
PubMed: 32949067
DOI: 10.1111/ped.14464 -
The Journal of Surgical Research Sep 2022The American Association of Pediatrics released guidelines in 2019 recommending delay of surgical referral in children with asymptomatic umbilical hernias until 4-5 y...
INTRODUCTION
The American Association of Pediatrics released guidelines in 2019 recommending delay of surgical referral in children with asymptomatic umbilical hernias until 4-5 y of age. The purpose of this study was to assess contemporary rates of potentially avoidable referrals in this cohort of children, and to assess whether rates have decreased following guideline release.
METHODS
Retrospective analysis of umbilical hernias referrals evaluated at a single pediatric surgery clinic from October 2014 to August 2021. Potentially avoidable referrals (PAR) were defined as asymptomatic, non-enlarging umbilical hernia referrals in a child 3 y of age or younger without a history of incarceration. Referral indication, disposition following clinic visit, and rates of PAR were compared before and after guideline release.
RESULTS
A total of 803 umbilical hernia referrals were evaluated, of which 48% were in children 3 y of age or younger at time of evaluation ("early" referrals). 33% of all referrals and 68% of early referrals were categorized as a PAR, and rates were similar before and after guideline release (all referrals: 32% versus 33%, P = 0.94; early referrals: 68% versus 67%, P = 0.94). Of the 333 early referrals who were managed expectantly per guideline recommendations, 2 (0.6%) developed incarceration which was managed with successful reduction and interval repair.
CONCLUSIONS
One-third of all referrals for umbilical hernia evaluation are potentially avoidable, and this rate did not change following release of American Academy of Pediatrics guidelines. Aligning expectations between surgeons and referring providers through improved education and guideline dissemination may reduce avoidable visits, lost caregiver productivity, and exposure to potentially avoidable surgery.
Topics: Child; Humans; Hernia, Umbilical; Referral and Consultation; Retrospective Studies; United States; Herniorrhaphy; Child, Preschool
PubMed: 35525211
DOI: 10.1016/j.jss.2022.04.022 -
Journal of Medical Case Reports Nov 2022Umbilical discharge in an adult is rare and generates broad diagnostic considerations. Umbilical anatomy is variable owing to congenital abnormalities and acquired...
BACKGROUND
Umbilical discharge in an adult is rare and generates broad diagnostic considerations. Umbilical anatomy is variable owing to congenital abnormalities and acquired pathology such as umbilical hernias. The umbilicus can be a site of primary or metastatic malignancy or endometriosis.
CASE PRESENTATION
A 40-year-old white American woman came to the clinic with a 2-day history of spontaneous umbilical bleeding. She reported periumbilical pain associated with nausea and emesis. There were no visible skin abnormalities, but deep palpation of the abdomen produced a thin, watery, serosanguineous fluid from the umbilicus. She experienced a similar episode of umbilical bleeding 5 years prior without clear cause. Laboratory workup was notable for mildly elevated C-reactive protein . Computed tomography imaging revealed a fat-containing umbilical hernia with fat necrosis, necessitating complete surgical resection of the umbilicus.
CONCLUSIONS
Umbilical hernia with fat necrosis is a rare condition that should be considered in adults with umbilical discharge. Additional diagnostic considerations in adults with spontaneous umbilical bleeding/discharge include embryonal remnants, omphalitis, and metastasis. If the cause is not readily apparent on physical exam, imaging with computed tomography should be considered to assess for hernia and embryonal anomalies.
Topics: Adult; Female; Humans; Umbilicus; Hernia, Umbilical; Fat Necrosis; Gastrointestinal Hemorrhage; Endometriosis; Skin Diseases; Neoplasms
PubMed: 36435796
DOI: 10.1186/s13256-022-03675-2 -
Cureus Apr 2022Umbilical hernia is a relatively common complication developing in patients with liver cirrhosis with recurrent ascites. Abdominal paracentesis is considered the...
Umbilical hernia is a relatively common complication developing in patients with liver cirrhosis with recurrent ascites. Abdominal paracentesis is considered the mainstay procedure to manage refractory ascites and to diagnose spontaneous bacterial peritonitis. Incarceration of umbilical hernia is a rare but serious adverse event following therapeutic paracentesis that requires prompt management. We describe a case of an incarcerated umbilical hernia following paracentesis requiring surgical repair in a cirrhotic patient.
PubMed: 35530876
DOI: 10.7759/cureus.23851 -
Gastroenterologie Clinique Et Biologique 2006
Review
Topics: Anti-Inflammatory Agents, Non-Steroidal; Ascites; Ascitic Fluid; Diuretics; Dopamine Antagonists; Hepatorenal Syndrome; Hernia, Umbilical; Humans; Liver Cirrhosis; Liver Transplantation; Metoclopramide; Mineralocorticoid Receptor Antagonists; Punctures; Randomized Controlled Trials as Topic; Recurrence; Spironolactone; Vasodilator Agents
PubMed: 16885871
DOI: 10.1016/s0399-8320(06)73334-6 -
Annals of the Royal College of Surgeons... Nov 1956
Topics: Hernia, Umbilical; Hernia, Ventral; Humans; Umbilicus
PubMed: 13373243
DOI: No ID Found -
Taiwanese Journal of Obstetrics &... Mar 2007Fetuses with omphalocele have an increased risk for chromosomal abnormalities. The risk varies with maternal age, gestational age at diagnosis, association with... (Review)
Review
Fetuses with omphalocele have an increased risk for chromosomal abnormalities. The risk varies with maternal age, gestational age at diagnosis, association with umbilical cord cysts, complexity of associated anomalies, and the contents of omphalocele. There is considerable evidence that genetics contributes to the etiology of omphalocele. This article provides an overview of chromosomal abnormalities associated with omphalocele and a comprehensive review of associated full aneuploidy such as trisomy 18, trisomy 13, triploidy, trisomy 21, 45,X, 47,XXY, and 47,XXX, partial aneuploidy such as dup (3q), dup (11p), inv (11), dup (1q), del (1q), dup (4q), dup (5p), dup (6q), del (9p), dup (15q), dup(17q), Pallister-Killian syndrome with mosaic tetrasomy 12p and Miller-Dieker lissencephaly syndrome with deletion of 17p13.3, and uniparental disomy (UPD) such as UPD 11 and UPD 14. Omphalocele is a prominent marker for chromosomal abnormalities. Perinatal identification of omphalocele should alert chromosomal abnormalities and familial unbalanced translocations, and prompt thorough cytogenetic investigations and genetic counseling.
Topics: Aneuploidy; Chromosome Aberrations; Female; Global Health; Hernia, Umbilical; Humans; Male; Uniparental Disomy
PubMed: 17389182
DOI: 10.1016/S1028-4559(08)60099-6 -
Yonsei Medical Journal Dec 2008The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not...
PURPOSE
The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures.
MATERIALS AND METHODS
The anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope.
RESULTS
One case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing.
CONCLUSION
These results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.
Topics: Adult; Aged; Aged, 80 and over; Autopsy; Female; Hernia, Umbilical; Humans; Ligaments; Male; Middle Aged; Umbilicus
PubMed: 19108025
DOI: 10.3349/ymj.2008.49.6.1004 -
Revista Brasileira de Ginecologia E... Jan 2022To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2 years of follow-up in a recent cohort at a tertiary center.
OBJECTIVE
To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2 years of follow-up in a recent cohort at a tertiary center.
METHODS
This is a retrospective clinical record review of all patients with gastroschisis and omphalocele admitted to the Neonatal Intensive Care Unit between January 2009 and December 2019.
RESULTS
There were 38 patients, 13 of whom had omphalocele, and 25 of whom had gastroschisis. Associated anomalies were present in 6 patients (46.2%) with omphalocele and in 10 (41.7%) patients with gastroschisis. Compared with patients with omphalocele, those with gastroschisis had younger mothers (24.7 versus 29.6 years; = 0.033), were born earlier (36 versus 37 weeks, = 0), had lower birth weight (2365 ± 430.4 versus 2944.2 ± 571.9 g; = 0.001), and had a longer hospital stay (24 versus 9 days, = 0.001). The neonatal survival rate was 92.3% for omphalocele and 91.7% for gastroschisis. Thirty-four patients were followed-up over a median of 24 months; 13 patients with gastroschisis (59.1%) and 8 patients with omphalocele (66.7%) had at least one adverse event, mainly umbilical hernia (27.3% vs 41.7%), intestinal obstruction (31.8% vs 8.3%), or additional surgical interventions (27.3% vs 33.3%).
CONCLUSION
Despite the high proportion of prematurity, low birth weight, and protracted recovery, gastroschisis and omphalocele (without chromosomal abnormalities) may achieve very high survival rates; on the other hand, complications may develop in the first years of life. Thus, a very positive perspective in terms of survival should be transmitted to future parents, but they should also be informed that substantial morbidity may occur in the medium term.
Topics: Birth Weight; Female; Gastroschisis; Hernia, Umbilical; Humans; Infant, Low Birth Weight; Infant, Newborn; Retrospective Studies
PubMed: 35092954
DOI: 10.1055/s-0041-1736299 -
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