Zens Tiffany J, Rogers Andrew, Cartmill Randi, Ostlie Daniel, Muldowney Bridget L, Nichol Peter, Kohler Jonathan E
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.
Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
Pediatr Surg Int. 2019 Apr;35(4):463-468. doi: 10.1007/s00383-018-4413-3. Epub 2018 Nov 14.
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.
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.
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.
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.
脐疝在幼儿中很常见。许多脐疝在4岁时会自行愈合，出现症状或发生嵌顿的风险极低。与无症状脐疝手术修复相关的并发症尚未得到充分阐明。我们分析了一家医院的数据，以检验年龄较小进行修复与并发症发生率增加相关这一假设。
对一家三级儿童专科医院在2007年至2015年期间进行的所有脐疝修复手术进行回顾性病历审查。对因无症状疝而接受单一手术修复的患者，按年龄、人口统计学特征和合并症评估术后并发症情况。
在308例脐疝修复手术中，204例为单纯性且无症状。与4岁以上儿童（3.1%，p = 0.034）相比，4岁以下儿童术后并发症更常见（12.3%）。所有呼吸并发症（n = 4）和再次入院（n = 1）均发生在4岁以下儿童中。
即使在同一机构内，儿童脐疝修复的年龄差异也很大，这表明修复时机可能取决于外科医生的决定。4岁以下患者术后更易出现并发症。脐疝通常会随着时间自行愈合，可以通过密切观察安全地进行监测。需要正式的指南来支持延迟修复并防止不必要的、可能有害的手术。
