Abstract：
Pediatric umbilical hernias are common congenital defects that regularly close without intervention. When spontaneous closure fails to occur, surgical herniorrhaphy is the standard of care. However, there are currently no national consensus guidelines describing the appropriate minimum age of surgical intervention for umbilical hernias. While many institutions recommend waiting until at least 4 years of age, others perform surgical intervention in younger children or base the timing of intervention on defect size. This paper aims to review the current literature and provide a recommendation for the timing of surgical referrals, including evaluating and weighing the risks associated with early operative intervention versus watchful waiting. Complications of untreated umbilical hernias are highly uncommon, with 1:1500 leading to incarceration of abdominal contents, and even fewer resulting in strangulation of the bowel. Comparatively, 12.3% of patients under 4 years old who undergo herniorrhaphy experience postoperative complications. Umbilical hernia repair younger than age 2 years is also associated with higher costs and higher rates of postoperative hospitalization and emergency room encounters. We recommend watchful waiting for uncomplicated pediatric umbilical hernia until 4 years of age and referral to a pediatric surgeon for those that fail to close beyond this.
摘要：
小儿脐疝是常见的先天性缺陷，经常在没有干预的情况下闭合。当自发闭合失败时，手术疝修补术是标准的护理。然而,目前尚无全国性的共识指南描述脐疝手术干预的适当最低年龄.虽然许多机构建议等到至少4岁，其他人对年龄较小的儿童进行手术干预或根据缺损大小确定干预时机.本文旨在回顾目前的文献，并为手术转诊的时机提供建议。包括评估和权衡与早期手术干预和观察等待相关的风险。未经治疗的脐疝的并发症非常罕见，1:1500导致腹部内容物被监禁，甚至更少导致肠窄。相对而言,12.3％的4岁以下接受疝修补术的患者术后并发症。小于2岁的脐疝修补术也与更高的成本和更高的术后住院率和急诊室遭遇率相关。我们建议警惕等待4岁以下无并发症的小儿脐疝，并将其转诊给儿科外科医生。
