M. Rosenberg1, A. Perez Coulter1, V. Pepper2, G. Banever2, D. Tashjian2, K. Moriarty2, M.V. Tirabassi2 1University of Massachusetts Chan Medical School – Baystate Medical Center, General Surgery, Springfield, MA, USA 2University of Massachusetts Chan Medical School – Baystate Medical Center, Pediatric Surgery, Springfield, MA, USA
Introduction: Umbilical hernias are a common pediatric surgical problem, typically repaired at 4-5 years of age in asymptomatic patients. Utilization of a vertical trans-umbilical incision (TUI) is a relatively new surgical approach theorized to have improved cosmetic outcomes. Our goal was to demonstrate the safety and efficacy of this approach as compared to the more traditional periumbilical incision (PUI).
Methods: A retrospective review was conducted of 505 pediatric patients under 18 years old who underwent an index open umbilical hernia repair for any indication at a single institution from 2013-2023. Patient demographics, operative outcomes including length of procedure, narcotic use, and post-operative complications were compared by incision type: PUI and TUI. Data were stratified by age and weight and were analyzed using student’s t-test.
Results: We analyzed 504 patients undergoing umbilical hernia repair. 406 (80.6%) had a PUI and 98 (19.4%) a TUI. Mean (standard deviation (SD)) age was 5.05 (3.52) years with a range from neonate to 18 years. Females represented 50.2% of patients, males 49.8%. There was no significant difference in age based on open incision type. 103 patients had concurrent operation, 69 with PUI and 33 with TUI. The majority of concurrent intraabdominal procedures were epigastric hernia repair (32%). Excluding all those with concurrent operations, PUI and TUI room time (79.2 v 83.3 min, p=0.10) and anesthetic time (37.8 v 33.2, p=0.31) were similar (Table 1). Mean intraoperative morphine milliequivalents (MME)/kg were similar between incision types (p=0.54). Average post-anesthesia care unit (PACU) MME/kg showed no significant difference between PUI and TUI (0.13 v. 0.26, p=0.15). Of note, PUI and TUI received a nerve block (transverse abdominis or rectus sheath) at similar rates (81% v 90%, p=0.06). There were 6 (1.5%) reported complications with no difference based on incision type: 4 recurrences (3 PUI, 1 TUI), 1 hospital readmission (PUI), and 1 patient with uncontrolled pain requiring overnight monitoring (PUI). No wound infections were observed in either group. When stratified by age and weight, there were still no significant differences in complication rates based on open incision type.
Conclusion: The TUI allows the scar to be hidden in the umbilicus, which has been previously reported to have an improved cosmetic outcome. Our findings support that TUI is a safe operative alternative in the pediatric population without an increase in post-operative complications, anesthetic time, or MME/kg utilization.