Indications and operation for umbilical hernia in children
An umbilical hernia occurs predominantly in infants, and in 80% of cases it closes without surgical treatment. The disease has typical symptoms, so its identification is not difficult. Removal of an umbilical hernia in children is carried out in case of complications, when the child is in danger in the form of death of organs and poisoning of the body with decay products.
This violation goes away on its own only if preventive measures are observed and conservative therapy corresponding to the symptoms is carried out.
It is imperative to operate on a hernia for newborns and infants when it is infringed. This complication has pronounced manifestations, and if they occur, parents should immediately call a doctor.
It is possible to cure an umbilical hernia without surgery, but this has its own nuances. If you do not strengthen the tissue in the area of the defect, there is a risk of recurrence of the disease. An operation to remove an umbilical hernia in children almost completely eliminates the likelihood of a recurrence of the protrusion.
How the disease progresses
A hernia can be congenital or acquired. The first occurs due to anatomical weakness of the muscles and intrauterine anomalies. Some newborns have connective tissue dysplasia, which will be an important factor in the appearance of the bulge.
The acquired disease is more often diagnosed at the age of 1-6 months and after a year of life, when the child begins to walk, and the load on the abdominal muscles increases. In addition, frequent crying, screaming, bloating will also affect the occurrence of a hernia of the umbilical ring after cutting the umbilical cord.
The pathological process begins with the expansion of the umbilical ring, through which the internal organs exit. In the hernial sac, there is often a loop of intestines and a greater omentum, it is these organs that can later be subject to infringement and death.
A hernia appears as an outwardly rounded or oval protrusion, which is reduced into the abdominal cavity with pressure and in the supine position. The formation is painless, but discomfort, bloating, colic may disturb.
A child with an umbilical hernia sometimes has nausea, he becomes capricious, and abdominal massage helps to alleviate this condition. If the symptoms do not subside for a long time and the condition only worsens, you need to call a doctor.
Indications for surgery
The child needs to have surgery in such cases:
- In protrusion in children over 6 years of age. Experts believe that after 6 years, the probability of self-reduction of the hernia is minimal, and infringement rather than closure of the umbilical ring will occur.
- X roundabout hernia . When the protrusion resembles a trunk, this also precludes reduction without surgery. Hernia repair in this case is carried out at the age of 1-2 years.
- About complications . When there is infringement, inflammation, intestinal obstruction, the operation is mandatory, otherwise there is a risk of organ necrosis and poisoning of the body, which can cause death.
- Giant hernias . _ _ When the umbilical ring expands more than 1 cm, surgical treatment is prescribed at the age of 3-5 years. Large formations disappear on their own in only 1% of cases.
The main indication for surgery will always be infringement.
Pinching is a condition in which compression of organs occurs, when blood circulation is disturbed, the organs begin to die. Symptoms of such a violation will be pain, nausea with vomiting, an increase in protrusion and the inability to correct it. A child with a strangulated hernia will cry and worry a lot, he becomes pale or the skin becomes bluish. The baby will feel so bad that he may lose consciousness from a sharp drop in blood pressure.
How is a hernia repair performed
To remove a hernia, the method of laparoscopic and open hernioplasty is used. The choice of operation will depend on the condition of the child and the amount of surgical manipulations required.
The intervention is performed under general anesthesia in young children and under local anesthesia after 6 years.
Access is created through a skin incision, then the surgeon selects the hernial sac, returns the organs to their place and removes it. Depending on the chosen technique of the operation, it ends with tissue closure or the installation of a mesh implant. To exclude the appearance of a hematoma, the doctor puts a cotton ball in the recess of the navel. After the operation, the wound is covered with a sterile dressing. This completes the operation, but an equally important stage begins - recovery after herniotomy.
Rehabilitation
Postoperative rehabilitation in children pursues the same goals as in adults. The growing body easily tolerates the operation, and recovery is faster. The rehabilitation period lasts an average of a month. At this time, it is important to exclude any load, monitor the activity of the baby, apply a postoperative bandage. After the operation, the child is discharged home, but the doctor will prescribe regular examinations to monitor the condition.
The postoperative bandage is prescribed for several weeks. It must be worn during therapeutic exercises, when the child plays and begins to walk. You can’t wear it all the time, the child should be in it no more than 3-4 hours a day.
About general rules in the postoperative period:
- eliminate bloating and constipation;
- do therapeutic exercises;
- put on an umbilical bandage;
- make sure that the child runs less and does not make sudden movements.
Forecast
What determines the prognosis of the operation:
- in young children, only general anesthesia is used, therefore, adverse reactions to anesthesia may occur, in this case the child will stay in the hospital longer, but there is no risk to life;
- the last meal before the operation should be in the evening, after which the child should completely refuse to eat;
- a few hours after the operation, the child can already get out of bed and move independently, and on the second day the patient is discharged home;
- a week after hernia repair, the bandage is removed, and from that moment you can start doing gymnastics.
If the child immediately begins to behave actively after the operation, this can cause a recurrence of the pathology, especially when tension hernioplasty was performed. If a mesh has been installed, this will almost completely eliminate the risk of recurrence of the disease.
Prevention
Recommendations during the rehabilitation period for the prevention of recurrence of umbilical hernia:
- diet, exclusion of bloating and constipation;
- bed rest the first day after surgery;
- exclusion of physical activity for the first week;
- wearing an umbilical bandage;
- prevention of respiratory diseases;
- therapeutic exercises after the healing of a surgical scar.
After hernioplasty, a small scar remains, which can be removed with cosmetic surgery. When installing a mesh implant, rehabilitation is faster, the umbilical bandage will have to be worn for no more than a month. To prevent relapse in adulthood, diet and physical activity must become a part of life, not a temporary measure.
After hernia repair, therapeutic nutrition is prescribed, but it should be followed for no more than 3 weeks, after which you can switch to your usual diet, but with some changes.
If the child is operated on urgently, he will be in the hospital for about a week, after which the doctor will prescribe a regimen and will regularly examine the baby.
After laparoscopic surgery, there is practically no scarring, and the risk of recurrence of the disease is lower. Despite minimal tissue trauma, even after laparoscopy, the child requires special attention from the surgeon, rehabilitation specialist, and gastroenterologist. To eliminate the consequences of the operation, the patient will be prescribed medications. The child is shown vitamin complexes, painkillers and non-steroidal anti-inflammatory drugs.
With inflammation and suppuration in a child's navel, you will need to undergo a course of antibiotic therapy. To prevent infection, it is important to make regular dressings, treat the wound and not wear a bandage on the naked body.
The prognosis after hernia repair is favorable, but the operation affects the child's condition, reducing physical activity. The correct choice of hernia removal technique and adequate preparation will be the key to the absence of complications and successful recovery.
