eMedicine Specialties > General Surgery > Abdomen

Abdominal Hernias: Follow-up

Author: Kimberly McCrudden Erickson, MD, Clinical Assistant Professor of Surgery, Co-director of Extracorporeal Life Support Program, C S Mott Children's Hospital, University of Michigan
Coauthor(s): Eustace Stevers Golladay, MD, Emeritus Clinical Professor of Pediatric Surgery, University of Michigan Medical Center; Consulting Staff, Department of Pediatric Surgery, Mott Children's Hospital
Contributor Information and Disclosures

Updated: Aug 28, 2009

Outcome and Prognosis

Uncomplicated inguinal and abdominal wall hernias do well. However, hernias with associated strangulation have an associated mortality rate of 10%. Infants with uncomplicated gastroschisis and omphalocele fare well with a mortality rate of less than 5%17 ; however, those with intestinal atresia or severe associated anomalies have a mortality rate of 15-50%.

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education articles Hernia and Hiatal Hernia.

Future and Controversies

The future of most abdominal wall hernias probably lies in laparoscopic approaches.18 As the cost of instrumentation decreases, procedure-specific instrument design improves, and the laparoscopic learning curve is obliterated, the saying that "if all else is equal, less pain and better cosmesis wins out" will hold true. For example, prospective studies out of Europe found laparoscopic repair of pediatric hernias to be comparable to the results of open surgery.19 The use of new materials or techniques may alter the approach.20

Controversy still exists on the correct approach to the contralateral side in pediatric inguinal hernias. Retrospective studies have suggested that the low incidence of contralateral hernia development in infants (younger than 1 y) and older children does not justify routine contralateral groin exploration.21,22 Peritoneoscopy through the open ipsilateral sac has been shown to be feasible, safe, and cost-effective in patients who might normally have undergone contralateral exploration.23

The proper approach to gastroschisis and omphalocele is in development. Data-driven decisions regarding the method and timing of both delivery and closure require further studies.

 


More on Abdominal Hernias

Overview: Abdominal Hernias
Workup: Abdominal Hernias
Treatment: Abdominal Hernias
Follow-up: Abdominal Hernias
Multimedia: Abdominal Hernias
References
Further Reading
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References

  1. Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. May 15 2007;165(10):1154-61. [Medline].

  2. Walker SH. The natural history of umbilical hernia. A six-year follow up of 314 Negro children with this defect. Clin Pediatr (Phila). Jan 1967;6(1):29-32. [Medline].

  3. deVries PA. The pathogenesis of gastroschisis and omphalocele. J Pediatr Surg. Jun 1980;15(3):245-51. [Medline].

  4. Chen CP. Syndromes and disorders associated with omphalocele (II): OEIS complex and Pentalogy of Cantrell. Taiwan J Obstet Gynecol. Jun 2007;46(2):103-10. [Medline].

  5. Mattix KD, Winchester PD, Scherer LR. Incidence of abdominal wall defects is related to surface water atrazine and nitrate levels. J Pediatr Surg. Jun 2007;42(6):947-9. [Medline].

  6. London JA, Utter GH, Sena MJ, et al. Lack of insurance is associated with increased risk for hernia complications. Ann Surg. Aug 2009;250(2):331-7. [Medline].

  7. Hamlin JA, Kahn AM. Herniography: a review of 333 herniograms. Am Surg. Oct 1998;64(10):965-9. [Medline].

  8. Toms AP, Dixon AK, Murphy JM, Jamieson NV. Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias. Br J Surg. Oct 1999;86(10):1243-9. [Medline].

  9. Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am. Aug 1998;45(4):773-89. [Medline].

  10. Manoharan S, Samarakkody U, Kulkarni M, Blakelock R, Brown S. Evidence-based change of practice in the management of unilateral inguinal hernia. J Pediatr Surg. Jul 2005;40(7):1163-6. [Medline].

  11. Bell C, Dubose R, Seashore J, Touloukian R, Rosen C, Oh TH, et al. Infant apnea detection after herniorrhaphy. J Clin Anesth. May 1995;7(3):219-23. [Medline].

  12. Pavlin DJ, Horvath KD, Pavlin EG, Sima K. Preincisional treatment to prevent pain after ambulatory hernia surgery. Anesth Analg. Dec 2003;97(6):1627-32. [Medline].

  13. Bonnard A, Zamakhshary M, de Silva N, Gerstle JT. Non-operative management of gastroschisis: a case-matched study. Pediatr Surg Int. Jul 2008;24(7):767-71. [Medline].

  14. Carlson GW, Elwood E, Losken A, Galloway JR. The role of tissue expansion in abdominal wall reconstruction. Ann Plast Surg. Feb 2000;44(2):147-53. [Medline].

  15. Anthony T, Bergen PC, Kim LT, Henderson M, Fahey T, Rege RV, et al. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. Jan 2000;24(1):95-100;discussion 101. [Medline].

  16. van Eijck FC, Wijnen RM, van Goor H. The incidence and morbidity of adhesions after treatment of neonates with gastroschisis and omphalocele: a 30-year review. J Pediatr Surg. Mar 2008;43(3):479-83. [Medline].

  17. Henrich K, Huemmer HP, Reingruber B, Weber PG. Gastroschisis and omphalocele: treatments and long-term outcomes. Pediatr Surg Int. Feb 2008;24(2):167-73. [Medline].

  18. Collaboration EH. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg. Jul 2000;87(7):860-7. [Medline].

  19. Schier F. Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J Pediatr Surg. Jun 2006;41(6):1081-4. [Medline].

  20. Martin DF, Williams RF, Mulrooney T, Voeller GR. Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications. Hernia. Aug 2008;12(4):379-83. [Medline].

  21. Ballantyne A, Jawaheer G, Munro FD. Contralateral groin exploration is not justified in infants with a unilateral inguinal hernia. Br J Surg. May 2001;88(5):720-3. [Medline].

  22. Given JP, Rubin SZ. Occurrence of contralateral inguinal hernia following unilateral repair in a pediatric hospital. J Pediatr Surg. Oct 1989;24(10):963-5. [Medline].

  23. Holcomb GW 3rd. Diagnostic laparoscopy for contralateral patent processus vaginalis and nonpalpable testes. Semin Pediatr Surg. Nov 1998;7(4):232-8. [Medline].

  24. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg. Mar 2000;231(3):436-42. [Medline].

  25. Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children. Anesth Analg. Jul 1998;87(1):52-6. [Medline].

  26. Snyder CL. Current management of umbilical abnormalities and related anomalies. Semin Pediatr Surg. Feb 2007;16(1):41-9. [Medline].

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Further Reading

Related eMedicine topics:
Gastroschisis
Hernia Inguinal Repair, Laparoscopic
Hernia Inguinal Repair, Open
Hernia Reduction
Hernias
Hydrocele and Hernia in Children
Omphalocele
Omphalocele and Gastroschisis
Pediatric Hernias

Clinical guidelines:
Hernia. Work Loss Data Institute - Public For Profit Organization.  2003 (revised 2008 Mar 10).  43 pages.  NGC:006559

Laparoscopic surgery for inguinal hernia repair. National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.].  2001 Jan (revised 2004 Sep).  33 pages.  NGC:004522

Clinical trials:
Inguinal Hernia Study Using Surgisis IHM

Strattice in Repair of Inguinal Hernias (RING)

Study of Hernia Repair Utilizing the Bard Ventrio Hernia Patch

Trial of Laparoscopic Compared to Open Inguinal Hernia Repair in Children Younger Than 2 Years

Watchful Waiting of Incisional Hernias

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Keywords

abdominal hernia, inguinal hernia, hernia surgery, umbilical hernia, repair hernia, inguinal hernia repair, hernia operation, femoral hernia, gastroschisis, omphalocele, incarcerated hernia, epigastric hernia, abdominal wall hernias, hernias of the groin, indirect inguinal hernia, direct inguinal hernia, femoral hernia, prevascular femoral hernia, femoral lymphadenopathy, spigelian hernia, supravesical hernia, obturator hernia, sciatic hernia, perineal hernia, superior lumbar hernia, Grynfeltt hernia, inferior lumbar hernia, Petit hernia, Littre hernia, Richter hernia
 
exomphalos, umbilical rest, umbilical granuloma, urachus, omphalomesenteric duct, ventral hernia, incisional hernia, lumbar hernia, interparietal hernias, congenital hernia, hydrocele of the canal of Nuck, hydrocele of the cord, osteogenesis imperfecta, silk sign, hydrocele, chronic hernia, hernia of Laugier, hernia of Cloquet, umbilical granuloma, umbilical polyp

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Contributor Information and Disclosures

Author

Kimberly McCrudden Erickson, MD, Clinical Assistant Professor of Surgery, Co-director of Extracorporeal Life Support Program, C S Mott Children's Hospital, University of Michigan
Kimberly McCrudden Erickson, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and Children's Oncology Group
Disclosure: Nothing to disclose.

Coauthor(s)

Eustace Stevers Golladay, MD, Emeritus Clinical Professor of Pediatric Surgery, University of Michigan Medical Center; Consulting Staff, Department of Pediatric Surgery, Mott Children's Hospital
Eustace Stevers Golladay, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Surgical Association, Central Surgical Association, Johns Hopkins Medical and Surgical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Alex Jacocks, MD, Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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