Treatment of umbilical hernia (exomphalos) abroad
Umbilical hernia is a type of hernia of the anterior abdominal wall when organs in the abdominal cavity protrude into the subcutaneous tissue through the umbilical ring. This illness is met among children as well as among the adults. Itsaverageis 5% of all the abdominal hernias.
Umbilical herniais 8 times common among children of Asian and African races compared to the Europeans. Risk group of the adult patients includes women over the age of 30 years who had several pregnancies in their medical history.
Umbilical hernia causes among children
Umbilical hernias are divided into:
- Childhood hernias
Embryonic hernias are a result of under development of the anterior abdominal wall during prenatal period. The possible content of such hernias is:
- Omentum and small intestine (usually)
- Large intestine
Child hood hernias appear after the birth, usually till 6 months of life. It is occur as a result of the immature umbilical ring. Content of the hernia sac most often includes the abdominal membrane. These hernias usually have favourable course and frequently disappear by them selves.
Umbilical hernia causes among the adults
Umbilical hernias among the adults can be:
Cause of the direct hernia is a thinned transverse fascia in the area of the umbilical ring. It protrudes into the subcutaneous tissue of the anterior abdominal wall through the shortest way – umbilical ring.
Indirect hernia occurs when fascia is thickened in the area of umbilical ring. Then the protrusion comes out higher or lower with the forming of the umbilical cord.
Pregnant women after the age of 30 are in the risk group of this illness. Hernias are frequent during the baby delivery which is associated with the increased intra-abdominal pressure. That’s why umbilical hernia is met among the adult women much more often than among men.
Risk factors are:
- Hereditary background
- Endocrine diseases
- Ascites (accumulation of fluid in the abdomen)
- Low protein level in the blood
Symptoms of umbilical hernia in children
While examining a child, doctor will notice a protrusion in the area of the umbilical cord that is covered by thinned skin. Content is easily tucked into the abdominal cavity. Afterwards, the edges of the hernia defect can be well palpated. They have different sizes – from several millimeters to 2 centimeters.
As a rule, umbilical hernia is painless. Rarely, it can be manifested by pain syndrome if hernia has large size. In this case, a child will show disturbance. Older kids might complain about pain in the abdomen and in the area of the discernible herniated protrusion. This happens in case of incarceration of a gut loop and tension of the mesenterium.
Umbilical hernia has favourable course for the majority of patients. It is incarcerated extremely rarely (about 1 case per 1500). Incarceration is possible if herniated defect is more than 1,5 cm in diameter.
Symptoms of umbilical hernia in adults
Clinical manifestations of the umbilical hernia mainly depend on its size. Hernia is often small and easily set to the place. Fewer hernias are not fixable. Then, abdominal adhesions appear in the area of the pathological process and fecal impaction can occur.
Clinically it is manifested through:
- Abdominal pain
- Complaints on the state of health worsening and decreasing work capacity
If umbilical hernia has small size it can:
- Appear only in vertical body position
- Be easily tucked in while in the horizontal body position
- Grow while coughing or pushing
- Have a round shape
Doctor has a chance to define a size of the herniated defect if it can be fixed. If hernia is not fixable, doctor can observe tuberous protrusion and small intestine edges can be seen through it. Protrusion has soft, elastic contents. Skin above the hernia sac is thinned.
Irreducible hernias can be incarcerated and thus, cause the bowel obstruction and further intestine necrosis. Irreducible hernias must be operated immediately.
Diagnostics of umbilical hernia (exomphalos)
For a diagnosis establishment it’s sufficient to examine a patient. Instrumental diagnostics methods help doctor to:
- Evaluate the size of the herniated defect
- Define the contents of the hernia sac
- Detect the process of adhesions
Ultrasound helps to find out all the details. Sometimes, herniography can be necessary - radiographic study with contrast.
Treatment of the umbilical hernia (exomphalos) abroad
Child hood hernia can fix by it self. That’s why during first years of life patients are provided with conservative therapy only. It includes the use of patches, bands, and bandages that prevent hernia sac from protrusion through the developed defect.
Physical therapy and massage are usually recommended for anterior abdominal wall strengthening.
Further, three outcomes are possible:
- Cure. Hernia disappears by itself among many kids before the age of 4-5.
- Hernia doesn’t reduce. Surgical treatment is performed. If hernia is up to 1 cm in size, the surgery is done when the child is 6 years old. If the diameter is over 1 cm, surgery is done when the child is 4 years old. If there is a large herniated defect more than 1, 5 cm in diameter and having a proboscis herniated protrusion, the surgery should be done during the second year of the child’s life.
- Hernia is incarcerated. In this case, surgery is indicated regardless of age, including newborns.
Hernia sac is set during the surgery and the defect is fixed. It can be done in different ways. There are surgeries with pulling and without it. When performing the procedure with pulling, the defect is closed by patient’s own tissues. Synthetic meshes are applied during operations without pulling. If hernia sac cannot be set to the place, it’s being excised and ligated.
Laparoscopy is possible in the number of cases. Then a doctor can also use a synthetic mesh. Laparoscopy is held through the small incisions that shortens the rehabilitation period and lowers the risk of complications. But, the procedure is only possible for the reducible hernias when a defect has a small size.
Umbilical hernia (Exomphalos) - Prognosis
Prognosis is favourable for the treatment of children umbilical hernia. It closes by itself by 3 years in 60% of patients. If this doesn’t happen, then illness can be well treated by the surgery.
Adult umbilical hernia cannot close by itself. Operation must be performed as soon as possible to prevent complications such as incarcerated hernia, inflammation of the hernia sac organs, intestine necrosis.
If surgery is done with pulling, umbilical hernia can reoccur and its risk is 10-15%. Risk of recurrence is lower when using synthetic meshes to close the herniated defect. In this case it doesn’t go over 2%.
A patient will fully restore his work capacity after the surgical treatment of hernia. Patients can have high level of physical activity and go in for sport after the rehabilitation period.