Reappraisal of adhesive strapping as treatment for infantile umbilical hernia

Long-term cosmetic outcomes of the slit-slide procedure for umbilical hernia repair in children

PURPOSE

To assess the long-term cosmetic outcomes of the "slit-slide procedure", designed to provide a more natural appearance for umbilical hernia repair, as perceived by the patients and their parents.

METHODS

A total of 149 patients with umbilical hernia underwent the slit-slide procedure at our hospital. The slit-slide procedure allows for the creation of an umbilicus with a more natural and integrated appearance. The patient satisfaction survey questionnaire was mailed to the families (n = 139), and there were 74 (53.2%) respondents. A questionnaire survey on postoperative appearance was also distributed to pediatric surgeons.

RESULTS

The median age at the time of operation was 2.5 years (range, 2 months to 14 years) and the average median age at the time of answering the questionnaire was 6.25 years old (range, 2.5-14.8 years). The average median period of observation was 3.2 years (range, 4 months to 8.97 years). Most patients (89.2%) and parents (93.2%) were satisfied with the appearance of the umbilicus. Twenty-seven patients reported improved satisfaction after surgery (36.2%). Surgeons tended to score the elongated-oval shape highly; however, there was no difference in satisfaction among the shapes.

CONCLUSION

The slit-slide procedure is not only effective and safe, but it achieves a satisfactory aesthetic outcome.

Efficacy of adhesive strapping on umbilical hernia in children: a systematic review and meta-analysis of cohort studies

Background

Although adhesive strapping (AS) for pediatric umbilical hernia (UH), which was once obsolete, has been reconsidered as a common practice in Japan, its efficacy is still unclear. This study aimed to evaluate its efficacy by reviewing related articles.

Methods

A comprehensive literature search of PubMed, Cochrane, Google Scholar, and Igaku Chuo Zasshi via Ichushi-Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Cohort studies reporting on the UH closure rate after AS compared with observation-only management were included.

Results

A total of 10 cohort studies were included, and the overall UH closure rate was not statistically significant (p=0.31, risk ratio (RR)=0.76, 95% confidence interval (CI) 0.45 to 1.28). However, there were significant differences in the UH closure rate at the age of 6 months (p<0.01, RR=0.55, 95% CI 0.41 to 0.75) and the efficacy of preventing protruding umbilici with redundant skin (p=0.049, RR=0.16, 95% CI 0.03 to 0.99).

Conclusions

Although the efficacy of AS on UH compared with observation-only management did not differ in terms of the UH closure rate, the application of AS may be effective for faster UH closure and the prevention of protruding umbilici. However, due to the high heterogeneity of the study, further large-scale studies, particularly randomized controlled trials, are warranted to reach a conclusion.

PROSPERO registration number

CRD42022314417.

Infantile umbilical hernia tape fixation method without compression materials

Background

Compression therapy using compression material is often used for umbilical hernias in infants; however, there are problems regarding its use, such as appearance and cost. In our hospital, we use the tape fixation method without compression materials. We report the effectiveness of this method, its significance in measuring the degree of hernia bulge before treatment, and parent satisfaction with the treatment.

Methods

We analyzed 77 cases of umbilical hernias (41 boys and 36 girls, mean age 52.7 ± 18.3 days) that were treated with the tape fixation method at the Department of Pediatrics of our hospital. Hernia size was classified based on the height of the bulge: mild (<1 cm), moderate (1≦ and <3 cm), or severe (>3 cm). Treatment duration was compared between the groups using the Steel-Dwass test. After the treatment, a questionnaire was mailed to the parents to assess the treatment satisfaction.

Results

Seventy-three patients (94.8%) achieved closure of the hernia orifice, with no excess skin and a well-shaped umbilicus. The duration of treatment was significantly shorter, with the following order: mild (18.5 ± 8.2 days), moderate (25.0 ± 11.9 days), and severe cases (47.8 ± 11.7 days). According to the questionnaire, 97.5% of the parents were satisfied with the treatment.

Conclusions

Our tape fixation method without compression material achieved a high closure rate and a good shape of the umbilicus. In addition, we noted that the height of the hernia bulge can be used as a guide to estimate the duration of treatment.

Incarcerated Umbilical Hernia Treated With Adhesive Strapping in a Three-Month-Old Infant

An umbilical hernia (UH) is a common condition in early childhood; it is defined as the protrusion of abdominal viscera through a defect in the umbilical ring. Since most UHs close spontaneously, almost no active treatment has been performed. Adhesive strapping (AS) for early UH closure is an easy-to-perform and relatively safe treatment. However, it can present rare but serious complications. Herein, we report a case of a three-month-old infant with incarcerated UH during AS therapy. AS treatment for UH, which has been reported mainly in Japan, has shown excellent results in observational studies and could be widely applied globally. However, our case demonstrated the presence of a noteworthy complication; incarcerated UH, in addition to skin complications, such as cellulitis and skin ulcer-related perforation, was associated with AS. To minimize the occurrence of these complications associated with AS treatment for UH, it is crucial to adequately explain and guide the family members regarding the proper management of AS and seeking medical care promptly when abnormalities occur during AS.

Nonoperative management for umbilical hernia in infants using adhesive strapping

BACKGROUND

The aim of this study was to evaluate the efficacy of adhesive strapping (AS) for umbilical hernia (UH) in infants.

METHODS

A retrospective review of 30 mature infants without any treatment for UH between January 2006 and December 2008 and 87 infants (42 mature and 45 premature) who were treated with AS between January 2010 and December 2014 was conducted. The rate and age of closure of UH were compared between the groups and the complications and limitations of AS were evaluated.

RESULTS

In the observation-only group, 24 UHs spontaneously closed at a mean age of 13.5 months, but a protruding umbilicus with redundant skin was present in three of 27 infants. Three infants had persistent UH, so a total of six infants, including the three with redundant skin and three with persistent UH, underwent surgery at the mean age of 30.0 months. In the AS group, 72 UHs were cured at a mean age of 4.3 months, which was significantly earlier than in the observation-only group (P < 0.01). Eleven infants did not continue AS because of skin irritation or discomfort. Four infants underwent repair due to persistent UH, but not for redundant skin of the umbilicus.

CONCLUSIONS

Adhesive strapping is effective for promoting the early resolution of UH in infants and preventing the forming of redundant skin, which can reduce the need for surgical intervention. To achieve better results with AS, we recommend applying this technique before the UH grows large.

Usefulness of adhesive strapping for umbilical hernias of infants

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.

A Systematic Review of Current Consensus on Timing of Operative Repair Versus Spontaneous Closure for Asymptomatic Umbilical Hernias in Pediatric

Introduction:

Umbilical hernia is a common pediatric disorder that pediatric surgeons are usually asked to manage. Most cases will be closed spontaneously during the first 4-5 years of life. Low number of studies regarding umbilical defects in children does not allow a definitive guideline to be drawn about their natural history, indications and optimal timing for repair. In this systematic review, we evaluated the existing literature where pediatric umbilical hernias are addressed in regards to watchful waiting versus recommendations on timing of operative repair and we compared our institutional results with current literature

Aim:

The aim of our study is to review and evaluate the current guidelines in management of umbilical hernias in children and to compare the results with our experience in management of umbilical hernia in our institution.

Methods:

Online literature search for studies that published about umbilical hernias in pediatric using literature’s search of ACP Journal Club, Clinical Evidence, Dynamed, Cochran Controlled Trial Register (1945-2015), UpToDate, and PubMed. We reviewed the recommendations of these studies regarding conservative treatment, rule and time of surgery, complications, and its natural history trend to close spontaneously. We compared the literature results and recommendations to our institutional results. We also conducted a retrospective medical charts review of 520 children aged between 1 month and 14 years presented to our institution for surgical consultation for asymptomatic umbilical hernia between 2007 and 2017. We only included children with umbilical hernia who are less than 14 years old and without other associated disorders.

Results:

A Total of 7 studies that met the inclusion criteria were reviewed. These studies examined the possibilities of spontaneous closure of hernia defect in pediatric, incidence of complications from watchful waiting and current recommendations for surgery timing. In general, spontaneous resolution were unlikely to be seen beyond the age of 5 years. Our institutional results found that of 442 cases treated conservatively between 2007 and 2017, 85% are closed spontaneously by 1-5 years of age.

Conclusion:

There is minimal top-notch clinical data guiding pediatric surgeons on management protocols in regards to umbilical hernias in children. Current published studies and our institutional retrospective study recommend that conservative management of asymptomatic, uncomplicated umbilical hernias until age 4-5 years is both safe and practical.

A Novel Cost-Effective Technique for Speedy Resolution of Infantile Umbilical Hernia: Ammannaya's Technique

Umbilical hernia in the infant is common and resolves in majority of the cases by 6 years of age. Observation till this age and surgery in the event of persistence are the widely followed management strategies. Trusses, taping, and adhesive strapping have been tried to achieve speedy resolution with variable success and a significant incidence of skin complications. We present a novel, simple, easily reproducible, and highly cost-effective technique to achieve complete resolution of infantile umbilical hernia in a span of 8 weeks, with no skin complications.

Umbilical hernia: Influence of adhesive strapping on outcome

BACKGROUND

Adhesive strapping for umbilical hernia has been re-evaluated as a promising treatment. We evaluated the influence of adhesive strapping on the outcome of umbilical hernia.

METHODS

We retrospectively evaluated patients with umbilical hernia referred to the present institution from April 2011 to December 2015. Patients who were treated with adhesive strapping were compared with an observation alone group. The adhesive strapping group was also subdivided into two groups: the cure group and the treatment failure group.

RESULTS

A total of 212 patients with umbilical hernia were referred to the present institution. Eighty-nine patients were treated with adhesive strapping, while 27 had observation only. The cure rate in the adhesive strapping group was significantly higher than that in the observation group. The duration of treatment of the adhesive strapping group was significantly shorter than that of the observation group. In the adhesive strapping group, the patients in the cure group were treated significantly earlier than those in the treatment failure group (P < 0.001). Furthermore, even in cases of umbilical hernia non-closure, surgical repair was easier after adhesive strapping.

CONCLUSION

Adhesive strapping represents a promising treatment for umbilical hernia. To achieve the best results, adhesive strapping should be initiated as early as possible.

Management of asymptomatic pediatric umbilical hernias: a systematic review

INTRODUCTION

Uncomplicated pediatric umbilical hernias are common and most close spontaneously. No formal practice guidelines exist regarding the optimal timing and indications for repair. The objective of this review is to examine the existing literature on the natural history of pediatric umbilical hernias, known complications of repair and non-operative approaches, and management recommendations.

STUDY DESIGN

A systematic literature search was performed to identify publications relating to pediatric umbilical hernias. Inclusion criteria comprised studies addressing recommendations for optimal timing of repair, evidence examining complications from hernias not operatively repaired, and research exploring the likelihood of pediatric umbilical hernias to close spontaneously. In addition, the websites of all pediatric hospitals in the United States were examined for recommendations on operative timing.

RESULTS

A total of 787 manuscripts were reviewed, and 28 met criteria for inclusion in the analysis. Studies examined the likelihood of spontaneous closure based on child's age and size of hernia defect, complications of unrepaired umbilical hernias including incarceration, strangulation and evisceration based on child's age and size of defect, incidence of postoperative complications and current recommendations for timing of repair. In addition, 63 (27.5%) of the United States pediatric hospital websites published a wide range of management recommendations.

CONCLUSION

Despite the high prevalence of pediatric umbilical hernias, there is a paucity of high quality data to guide management. The literature does suggest that expectant management of asymptomatic hernias until age 4-5years, regardless of size of hernia defect, is both safe and the standard practice of many pediatric hospitals.

TYPE OF STUDY

Review Article.

LEVEL OF EVIDENCE

Level IV.