Hernia in children: surgery and rehabilitation

The anterior abdominal wall has a number of weak points (for example, umbilical ring, white abdominal line, inguinal rings , etc.) in which hernias can form. What it is? Hernias - the exit of organs and tissues from the place of their usual location through openings formed naturally or as a result of pathological processes.

Etiology of umbilical hernia

The incidence of this pathology is 4%. It is diagnosed, as a rule, at the stage of newborn.

Why is an umbilical hernia formed ? The main cause is a disruption in the healing of the umbilical wound after the umbilical cord has fallen off. Normally, the umbilical ring should close and complete closure of the wound. However, the peculiarities of the structure of this region contribute to the appearance of a hernial protrusion.

The umbilical ring is well closed only in the lower part, where the umbilical arteries and the urinary duct pass. These education data are needed only at the stage of embryonic development, after birth they are replaced by a dense connective tissue.

The umbilical vein passes through the upper part of the umbilical ring, which after birth is also replaced by a fibrous tissue. However, one vein usually can not ensure the formation of such a dense and broad site of connective tissue, as in the lower part of the ring. In addition, if abdominal fascia is underdeveloped, which normally should strengthen the umbilical ring, the 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 promotes the exit of organs beyond its limits. Weak places become a hernial portal.

What is the prerequisite for the appearance of umbilical hernia in children?

1. Prematurity.
2. Light weight.
3. Weak muscles.
4. Constipation.
5. Cough.
6. Restless behavior, frequent screaming.

Clinical picture and diagnosis

Umbilical hernia - rounded formation in the navel. Dimensions can vary greatly. Usually in the supine position, when the child is calm and does not cry, the hernia itself disappears. It is possible to palpate an unclosed umbilical ring.

When the baby sits or stands, when he screams, thereby provoking an increase in pressure in the abdominal cavity, the hernia again becomes noticeable.

No unpleasant sensations this pathology does not cause. The main problem is a cosmetic defect. It is not necessary, however, to forget about the constantly existing risk of infringement. Although, if we talk about umbilical hernias, among them this complication is rare.

What should I do if my baby has a hernia?

How is the umbilical hernia treated in children? Operation or conservative methods - which is preferable? Let's try to figure it out.

At once it is necessary to tell, that approximately in 60% of cases the problem is resolved independently during growth and development of the child. Unfortunately, this is not always the case.

This is a very common problem - an umbilical hernia in children, treatment without surgery is possible and, moreover, with the proper implementation of recommendations fairly effectively. Of course, at a certain age.

How correctly is the umbilical hernia treated in children? The operation is by no means the only method. We should start from quite another:

1. Daily massage and gymnastics. You must put the baby on your tummy. It is best to do this before feeding. This simple action will allow you to escape from the intestine accumulated there gases and improve digestion, which means that the child will be less worried because of intestinal colic. In addition, in the prone position on the abdomen, an increase in the tone of the muscles 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 in a clockwise direction.
2. Fixation of the hernial sac in the corrected state. Not so long ago, we recommended that the belly button be stuck with a band-aid for several days so that the contents of the hernia remained in the abdominal cavity, not protruding outward. However, the adhesive plaster has the property of irritating the skin with prolonged use and in general cause unpleasant sensations, which means that the baby will constantly worry. It is much more effective and comfortable for a child to use a special bandage, which is an elastic waistband with a thickening opposite the navel. It is not very wide, so it will not prevent the child from actively moving around and learning the world, fastens on velcro, easily removable and put on, if necessary, it can be washed. Modern bandages are made from hypoallergenic materials, so they do not irritate the skin, unlike the adhesive plaster.
3. Swimming also helps to strengthen the muscles of the abdominal wall.

At what age is the operation performed?

When 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 the conservative methods discussed above are applied. The operation to remove umbilical hernia in children is performed at the age of over 5 years. This is when it comes to planned surgical treatment. One should never forget that any hernia, even the umbilical, can be restrained, creating the need for an emergency operation (of course, when it comes to saving lives, age limits are not taken into account).

7 years old is the middle age, when the umbilical hernia operation is most often performed for children. You can, of course, later. But it is better to eliminate the problem sooner, because with age new interests and hobbies begin to appear, which for the sake of several days of hospital stay is more difficult to postpone. And the operation is postponed indefinitely, while the hernia may someday be seized and transformed from a small cosmetic defect into a life-threatening one.

What types of surgical interventions exist?

There are 2 groups of operations used in the treatment of umbilical hernias:

1. Stretching techniques, when the hernial gates are closed with local tissues (operations on Mayo, Sapezhko, Lexer).
2. Use of artificial implants (mesh) to close the abdominal wall defect. The operation is indicated for the treatment of hernias of large sizes and in adulthood, so this method will not be considered in this article.

Umbilical hernia in children: Mayo operation

The incision is made in the transverse direction, bordering the navel. Transversely, the aponeurosis of the rectus abdominis is dissected. The hernial sac is opened, its contents are immersed in the abdominal cavity, the sheets of the parietal peritoneum forming the walls of the sac are sewed together.

To strengthen this area and prevent relapse, duplication (double layer) of the aponeurosis is created, ie, its sheets are sewn together so that the lower one is located above the aponeurosis. Then the wound is sewn layer by layer. Duplicate is thus formed in the transverse direction.

This operation is often used after reaching adolescence and with a large hernia.

Operation Sapezko

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 the cosmetic point of view, it may be more aesthetically pleasing, but this method is inferior in strength to Mayo's operations. Duplication in the transverse direction is much less influenced by intra-abdominal pressure, which means that the risk of relapse after Mayo surgery is lower.

How is the umbilical hernia treated in children? Operation on Mayo and Sapezhko - methods, preferable for adults. To eliminate hernia in young children, the Lexer method is most common.

Umbilical hernia in children 7 years old. Operation on Lexer

Under a hernial protrusion, a semilunar incision is performed. The hernia refreshes, the suture seam is put on the umbilical ring and tightens, thereby eliminating the hernial gates. The wound is sewn layer by layer.

This is how the umbilical hernia in children is mainly treated. The operation, the reviews about which are quite positive (a small incision, a quick recovery), is the method of Lekser described above. At the present time, however, little-traumatic surgery is gaining more and more development.

Laparoscopic removal of a hernia

This is the newest method of eliminating the umbilical hernia, as well as establishing a reticular implant if necessary. In this case, no large incisions are required, all manipulations are performed through the punctures of the abdominal wall with the help of special instruments.

This method has high efficiency, good cosmetic result, rapid recovery of the patient after surgery.

Rehabilitation stage

The child after an operation to remove the umbilical hernia must strictly observe all the prescriptions of the attending physician in order to avoid the occurrence of complications or relapse of the disease.

1. Compliance with diet, especially in the first week. Hard and heavy food is excluded. Preference is given to broths, juices, kissels. You can diversify the diet from the second week, but it should be done gradually.
2. Restriction of physical activity. Actively engage in physical education can be no earlier than a month after surgery.
3. Wearing a postoperative bandage in case the child suffers from excessive body weight.
4. Massage - as for newborns (description is given above).

Let's sum up the results

It should not be forgotten that only the timely treatment started is most effective. In the first six months of life, fighting with the umbilical hernia is not an easier example than at an age when the baby starts actively crawling, does not want to lie on his stomach and resists the massage.

After 5 years, conservative methods of treatment become ineffective. If you keep the umbilical hernia at this age, you should think about the operation.