A healthy 18-month-old girl is found to have an umbilical hernia with a fascial defect measuring 1 cm. The hernia reduces easily and has never been irreducible. What is the correct management?
- A Observation, as most such defects close spontaneously by 4 to 5 years ✓
- B Adhesive strapping applied over the hernia daily
- C Elective mesh hernioplasty now
- D Suture repair of the defect at 2 years of age regardless of size
Correct answer: A. Observation, as most such defects close spontaneously by 4 to 5 years
Explanation
Small umbilical hernias in infants close spontaneously as the rectus muscles develop, and the great majority of defects under 1.5 cm disappear by school age. Strapping is ineffective and causes skin problems, so it is not advised. Surgical repair is reserved for defects that persist beyond about 4 to 5 years of age, defects larger than roughly 1.5 to 2 cm, or complications such as irreducibility. Mesh is unnecessary in children with small defects.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.