The anterior abdominal wall has a number of weak points (for example, the umbilical ring, white line of the abdomen, inguinal rings, etc.), in which hernias can form. What it is? Hernias are the exit of organs and tissues from their usual location through holes formed naturally or as a result of pathological processes.
Umbilical hernia etiology
The incidence of this pathology is 4%. It is diagnosed, as a rule, even at the neonatal stage.
Why does an umbilical hernia form? The main reason is a violation of the healing of the umbilical wound after the umbilical cord has fallen off. Normally, the umbilical ring should close and the wound should close completely. However, the structural features of this area contribute to the appearance of a hernial protrusion.
The umbilical ring closes well only in the lower part, where the umbilical arteries and urinary duct pass. These formations are needed only at the stage of embryonic development, after birth they are replaced by dense connective tissue.
Through the upper part of the umbilical ring passesthe umbilical vein, which also undergoes replacement with fibrous tissue after birth. However, one vein usually cannot provide the formation of such a dense and wide area of connective tissue as in the lower part of the ring. In addition, if there is an underdevelopment of the abdominal fascia, which normally should strengthen the umbilical ring, its upper part becomes a place potentially favorable for the formation of hernias.
How does a hernia form?
The pathogenesis of any hernial protrusion is based on the discrepancy between the strength of the abdominal wall and the increase in pressure in the abdominal cavity, which contributes to the exit of organs beyond its limits. Weak spots become hernial orifices.
What causes an umbilical hernia in children?
- Prematurity.
- Light weight.
- Muscle weakness.
- Constipation.
- Cough.
- Restless behavior, frequent crying.
Clinical presentation and diagnosis
Umbilical hernia - a rounded formation in the navel. Sizes can vary greatly. Usually in the supine position, when the child is calm and does not cry, the hernia disappears on its own. In this case, an open umbilical ring can be palpated.
When the baby is sitting or standing, when he screams, thereby provoking an increase in pressure in the abdominal cavity, the hernia becomes noticeable again.
This pathology does not cause any discomfort. The main problem is a cosmetic defect. However, one should not forget about the constantthe existing risk of infringement. Although, if we talk about umbilical hernias, this complication is quite rare among them.
What should I do if my baby has a hernia?
How is umbilical hernia treated in children? Surgery or conservative methods - which is preferable? Let's try to figure it out.
It should immediately be said that in about 60% of cases the problem is resolved independently in the process of growth and development of the child. Unfortunately, this is not always the case.
This is a very common problem - umbilical hernia in children, which can be treated without surgery and, moreover, if the recommendations are followed correctly, it is quite effective. Of course, at a certain age.
How is umbilical hernia treated in children? Surgery is far from the only method. You should start from a completely different point:
- Daily massage and gymnastics. The baby must be placed on the tummy. It is best to do this before feeding. This simple action will allow the gases accumulated there to leave the intestines and improve digestion, which means that the child will be less worried about intestinal colic. In addition, in the supine position, an increase in the tone of the muscles of the anterior abdominal wall is stimulated, which is favorable for the treatment of umbilical hernia. An equally effective action is circular strokes around the navel in a clockwise direction.
- Fixation of the hernial sac in the reduced state. Not so long ago, it was recommended to seal the navel with adhesive tape for several days so that the contents of the hernia remain in the abdominal cavity.cavities without protruding outward. However, the adhesive plaster tends to irritate the skin with prolonged use and generally cause discomfort, which means that the baby will constantly worry. It is much more effective and comfortable for the child to use a special bandage, which is an elastic belt with a thickening opposite the navel. It is not wide, so it will not interfere with the child to actively move around and explore the world, fastens with Velcro, can be easily removed and put on, if necessary, it can be washed. Modern bandages are made from hypoallergenic materials, so they do not irritate the skin, unlike adhesive tape.
- Swimming also helps to strengthen the muscles of the abdominal wall.
At what age is the operation performed?
When an umbilical hernia is diagnosed in children, treatment (including surgery) should be performed in a timely manner and within a certain age interval. Up to 5 years, for example, only conservative methods are used, which were mentioned above. An operation to remove an umbilical hernia in children is performed over the age of 5 years. This is if we talk about planned surgical treatment. We should never forget that any hernia, even an umbilical one, can be infringed, creating the need for an emergency operation (of course, when it comes to saving a life, age restrictions are not taken into account).
7 years is the average age at which umbilical hernia surgery is most common in children. You can, of course, later. But it's better to fix the problem before,after all, with age, new interests and hobbies begin to appear, which are more and more difficult to postpone for the sake of several days of stay in a hospital. And the operation is always postponed indefinitely, while the hernia may someday become strangulated and turn from a small cosmetic defect into a threat to life.
What types of surgery are there?
There are 2 groups of operations used in the treatment of umbilical hernias:
- Tension techniques when the hernial orifice is closed with local tissues (Mayo, Sapezhko, Lexer operations).
- The use of artificial implants (mesh) to close the defect of the abdominal wall. The operation is indicated for the treatment of large hernias and in adulthood, therefore, this method will not be considered in this article.
Umbilical hernia in children: Mayo surgery
The incision is made in the transverse direction, bordering the navel. The aponeurosis of the rectus abdominis muscles is transversely dissected. The hernial sac is opened, its contents are immersed in the abdominal cavity, the sheets of the parietal peritoneum, which form the walls of the sac, are sutured.
To strengthen this area and prevent recurrence, a duplication (double layer) of the aponeurosis is created, i.e. its sheets are sewn together so that the lower one is above the upper one. The wound is then sutured in layers. The duplication is thus formed in the transverse direction.
This operation is more often used after reaching adolescence and in the presence of a large hernia.
Operation on Sapezhko
The technique for performing this operation is similar to the Mayo method. The difference lies in the fact that the incision and the formation of the duplication are carried out in the longitudinal direction. From a cosmetic point of view, this may be more aesthetically pleasing, but in terms of strength, this method is inferior to the Mayo operation. The transverse duplication is much less affected by intra-abdominal pressure, which means that the risk of recurrence after Mayo surgery is lower.
How is umbilical hernia treated in children? Mayo and Sapezhko surgery are methods preferred by adults. To repair a hernia in young children, the Lexer method is most common.
Umbilical hernia in children 7 years old. Lexer operation
Under the hernial protrusion, a crescent-shaped incision is made. The hernia is reduced, a purse-string suture is applied to the umbilical ring and tightened, thereby eliminating the hernial orifice. The wound is sutured in layers.
This is how umbilical hernia in children is basically treated. The operation, the reviews of which are quite positive (small incision, quick recovery), is the Lexer method described above. Currently, however, low-traumatic surgery is gaining more and more development.
Laparoscopic hernia repair
This is the latest method of repairing an umbilical hernia, as well as installing a mesh implant if necessary. In this case, no large incisions are required, all manipulations are carried out through punctures of the abdominal wall using special instruments.
Thisthe method has high efficiency, good cosmetic result, fast recovery of the patient after surgery.
Rehabilitation stage
A child after an operation to remove an umbilical hernia must strictly follow all the instructions of the attending physician in order to avoid complications or recurrence of the disease.
- Dieting, especially in the first week. Excluded solid and heavy food. Preference is given to broths, juices, jelly. You can diversify the diet from the second week, but this should be done gradually.
- Restriction of physical activity. You can actively engage in physical education no earlier than a month after surgery.
- Wearing a postoperative bandage if the child is overweight.
- Massage - as for newborns (described above).
Summarize
It should not be forgotten that only timely treatment is most effective. In the first six months of life, dealing with an umbilical hernia is much easier than at the age when the baby begins to actively crawl, does not want to lie on his stomach and resists massage.
After 5 years, conservative treatments become ineffective. If an umbilical hernia persists at this age, surgery should be considered.
