The anterior abdominal wall has a number of weak points (for example, the umbilical ring, the white line of the abdomen, inguinal rings , etc.), in which hernias can form. What it is? Hernia - the exit of organs and tissues from their usual location through holes formed naturally or as a result of pathological processes.
Etiology of umbilical hernia
The frequency of occurrence of this pathology is 4%. It is diagnosed, as a rule, at the neonatal stage.
Why is an umbilical hernia formed ? The main reason is a violation of the healing of the umbilical wound after the umbilical cord falls off. Normally, the umbilical ring closes and the wound closes completely. However, the structural features of this area contribute to the appearance of 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.
An umbilical vein passes through the upper part of the umbilical ring, which, after birth, is also replaced by fibrous tissue. 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 is a hernia formed?
The pathogenesis of any hernial protrusion is based on a mismatch 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 gates.
What is the prerequisite for the appearance of umbilical hernia in children?
- Prematurity.
- Light weight.
- Muscle weakness.
- Constipation
- Cough.
- Restless behavior, frequent screaming.
The clinical picture and diagnosis
Umbilical hernia is a round 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 sits or stands, when he screams, thereby provoking an increase in pressure in the abdominal cavity, the hernia again becomes noticeable.
This pathology does not cause any unpleasant sensations. The main problem is a cosmetic defect. However, one should not forget about the constantly existing risk of infringement. Although, if we talk about umbilical hernias, among them this complication is quite rare.
What to do if a child 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, treatment without which is possible 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? Operation is far from the only method. You should start from a completely different perspective:
- 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 exit 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 muscle tone of the anterior abdominal wall is stimulated, which is favorable for the treatment of umbilical hernia. No less effective action - circular strokes around the navel clockwise.
- Fixing the hernial sac in the set state. Not so long ago, it was recommended to stick the navel over with a band-aid for several days so that the contents of the hernia would remain in the abdominal cavity without bulging out. However, the adhesive plaster tends to irritate the skin with prolonged use and generally cause discomfort, which means the baby will constantly worry. It is much more effective and more comfortable for the child to use a special bandage, which is an elastic belt with a thickening opposite the navel. It is not wide, therefore, it will not prevent the child from actively moving and exploring the world, fastens with Velcro, can be easily removed and put on, if necessary, it can be washed. Modern bandages are made of hypoallergenic materials, so they do not irritate the skin, unlike an adhesive plaster.
- 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 at 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. You should never forget that any hernia, even umbilical, can be infringed, creating the need for an emergency operation (naturally, when it comes to saving lives, age restrictions are not taken into account).
7 years is the average age when the most commonly performed umbilical hernia surgery is for children. You can, of course, later. But it’s better to fix the problem earlier, because with age new interests and hobbies begin to appear, which, for the sake of a few days in the hospital, are becoming increasingly difficult to postpone. And the operation is always postponed for an indefinite period, while a hernia may one day be squeezed and turn from a small cosmetic defect into a threat to life.
What types of surgical interventions exist?
There are 2 groups of operations used in the treatment of umbilical hernias:
- Stretch techniques when hernial gates are closed with local tissues (operations according to Mayo, Sapezhko, Lexer).
- The use of artificial implants (mesh) to close the abdominal wall defect. The operation is indicated for the treatment of large hernias in adulthood, so 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 is transversely dissected. The hernial sac is opened, its contents are immersed in the abdominal cavity, the sheets of the parietal peritoneum that form the walls of the sac are sutured.
To strengthen this area and prevent relapse, a duplication (double layer) of aponeurosis is created, i.e. its sheets are stitched so that the lower one is above the upper one. Next, the wound is sutured in layers. Duplicate 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 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 duplication are carried out in the longitudinal direction. From a cosmetic point of view, this may be more aesthetically pleasing, but this method is inferior in strength to the Mayo operation. Duplication in the transverse direction is much less affected by intra-abdominal pressure, which means that the risk of relapse after Mayo surgery is lower.
How is umbilical hernia treated in children? Mayo and Sapezhko surgery are preferred methods for adults. To eliminate 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 half-moon incision is made. The hernia is repaired, a purse string suture is applied to the umbilical ring and tightened, thereby eliminating the hernia gate. The wound is sutured in layers.
This is exactly how umbilical hernia in children is mainly treated. The operation, the reviews about which are quite positive (a small incision, a quick recovery), is the Lexer method described above. Currently, however, less traumatic surgery is being developed.
Laparoscopic hernia repair
This is the newest method for eliminating umbilical hernia, as well as establishing 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 tools.
This method has high efficiency, good cosmetic result, quick recovery of the patient after surgery.
Rehabilitation phase
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 relapse of the disease.
- Compliance with diet, especially in the first week. Solid and heavy foods are excluded. Preference is given to broths, juices, jelly. You can diversify the diet from the second week, but this should be done gradually.
- Limitation 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 (description above).
To summarize
It should not be forgotten that only timely treatment initiated is most effective. In the first six months of life, fighting an umbilical hernia is not an example easier than at an age when the baby begins to crawl actively, does not want to lie on his stomach and resists massage.
After 5 years, conservative treatment methods become ineffective. When preserving an umbilical hernia at this age, you should think about surgery.