An asymptomatic 18-month-old child has an umbilical hernia with a 0.8 cm fascial defect that reduces easily. The parents ask whether surgery is needed. What is the correct advice?
- A Repair now, because strangulation risk peaks in the second year of life
- B Apply adhesive strapping across the hernia to encourage closure
- C Observe, as most close spontaneously by 2 to 3 years, and repair only if it persists beyond that or enlarges ✓
- D Repair immediately regardless of size, because all childhood umbilical hernias eventually strangulate
Correct answer: C. Observe, as most close spontaneously by 2 to 3 years, and repair only if it persists beyond that or enlarges
Explanation
Umbilical hernias in children are extremely common and most defects under 1 to 1.5 cm close spontaneously by 2 to 3 years of age. Strangulation in children is rare, so observation is safe provided the hernia reduces easily. Repair is advised if the defect persists beyond about 2 to 3 years, exceeds 1.5 cm, or enlarges. Adhesive strapping is ineffective and causes skin complications, and it does nothing to aid fascial closure.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.