The current recommendations available on literature in regards to the exact timing of surgical repair for asymptomatic pediatric umbilical hernias show no evidence for a particular management strategy. In contrast to complicated or symptomatic hernias where an immediate repair is frankly recommended.
While reviewing the literature, we found there is a strong consensus that umbilical hernias in pediatric age groups have the predisposition to close spontaneously especially during the first 3 years of life unlike hernias in adult. Our own retrospective cohort study has also the same conclusions.
This natural history of spontaneous closure of umbilical hernias in pediatric has the advantage of avoiding unnecessary operations, and complications of anesthesia and surgeries. This natural trend is also cost effective to health care facilities.
There is significant variability in author recommendations surrounding surgical repair of asymptomatic pediatric umbilical hernias. The majority of studies in this review concluded no increased risk of complication in children less than 6 years old, meanwhile anesthesia literature suggests an increased risk of neurologic and respiratory complications in children less than 6 years of age 14, 15.
The majority of manuscripts recommendation were supporting the watchful waiting over surgical repair for asymptomatic umbilical hernias in children younger than 5 years old. There was no association between size of the defect and likelihood of developing strangulation or incarceration. Although larger defects may be less likely to close and eventually require surgery, several small studies have demonstrated the possibility of spontaneous closure later in childhood.
Asymptomatic umbilical hernias in pediatric are a common pathology that encountered by most of pediatric and many general surgeons in their outpatient offices or in emergency department. Little recommendations were found in literature in regards to timing of surgical repair since the vast majority are resolved spontaneously with very minimal complications on watchful waiting strategy.