medwireNews: Eighty percent of umbilical hernias (UHs) resolve spontaneously by the age of 5 years regardless of size, allowing children to avoid surgery before this time, US study findings confirm.
“These results provide new insight for primary care clinicians, surgeons, and caregivers that can better inform discussions around the timing of repair,” say Shawn Rangel and co-workers from Boston Children’s Hospital in Massachusetts, USA.
They explain in a letter to JAMA Pediatrics that while the majority of UHs spontaneously close, the lack of population-based data on spontaneous resolution has led to “practice variation” and “conflicting recommendations” on the optimal timing of repair.
To investigate further, the team reviewed electronic medical records for 165,557 children registered with primary care practices associated with Boston Children’s Hospital by September 2022, identifying 4486 patients (50.3% boys) with an UH diagnosed at a median age of 1.6 months.
Spontaneous UH closure – as identified by a specific mention of UH absence in medical records or two consecutive well-child visit records without UH documentation – occurred in 88.6% of children by the age of 5 years.
For children with a persistent UH at age 3 years, there was a 20.0% probability of spontaneous closure by age 4 years and a 34.8% probability by age 5 years, the investigators say.
UH size was described for 76.3% of the children, with the majority (84.8%) reported as having small UHs or UHs of no more than 1 cm. These patients were significantly more likely to experience spontaneous resolution than the 15.2% of children with larger UHs, with 5-year rates of 89.5% and 80.1%, respectively.
Nevertheless, the researchers describe the likelihood of spontaneous closure between the ages of 3 and 5 years as being “relatively high independent of size,” with the probability of spontaneous resolution of small and large hernias in this time frame of 37.0% and 29.4%, respectively.
“Limitations of this study include its retrospective design and reliance on [electronic health record] documentation, although the results are likely to be generalizable and valid based on the robust study cohort and methods used to minimize misclassification,” say Rangel et al.
“Despite these limitations, the results of this analysis suggest that repair should be delayed in most children until age 5 years,” they advise.
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