Hernias of the anterior abdominal wall

Abstract

The first edition of the clinical guidelines on anterior abdominal wall hernias, developed by specialists from the Russian Association of Pediatric Surgeons, includes information on the diagnosis and treatment of this disease. The authors used data of domestic and international clinical trials, including systematic reviews and meta-analyses.

The clinical guidelines underline the role of ultrasound examination of the scrotum organs in diagnosing the inguinal hernia, if findings of clinical examination of a child are doubtful. Criteria and indications for emergency and conservative treatment of a strangulated inguinal hernia are described. In case of oblique hernias, the treatment is directed to disconnecting the communication of the vaginal process of the peritoneum (which is in fact a hernial sac) with the abdominal cavity, so as to prevent protrusion of the abdominal organs through the inguinal canal. The authors underline that despite the fact that the only effective method of treating inguinal hernias is a surgical one, still the choice of a surgical technique depends on the surgical team and resources of their medical setting.

In addition to inguinal hernia, the presented clinical guidelines describe basic modalities for diagnosis and treatment of umbilical hernia and hernia of the white line of the abdomen.

Keywords

anterior abdominal wall / abdomen white line hernia / umbilical hernia / oblique inguinal hernia / direct inguinal hernia

References

[1] Pediatric surgery: National guidelines. Ed. by A.Y. Razumovsky. 2nd ed., revised and updated. Moscow: GEOTAR-Media; 2021. 1280 p. (National Guidelines Series). (In Russ.) doi: 10.33029/9704-5785-6-PSNR-2021-2-1-1280 EDN: CYXTIN

[2] Isakova YuF, Stepanov EA, Krasovskaya TV. Abdominal surgery in children: A guide. Moscow: Meditsina; 1988. 416 p. (In Russ.)

[3] Khan FA, Jancelewicz T, Kieran K, Islam S; Committee on Fetus and Newborn; Section on Surgery; Section on Urology. Assessment and management of inguinal hernias in children. Pediatrics. 2023;152(1):e2023062510. doi: 10.1542/peds.2023-062510

[4] Rowe MI, Copelson LW, Clatworthy HW. The patent processus vaginalis and the inguinal hernia. J Pediatr Surg. 1969;4(1):102–107. doi: 10.1016/0022-3468(69)90189-4

[5] Aiken JJ. Inguinal hernias. In: Behman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics, 17th. Saunders, Philadelphia; 2004. 1293 p.

[6] Tanyel FC, Müftüoglu S, Dagdeviren A, et al. Myofibroblasts defined by electron microscopy suggest the dedifferentiation of smooth muscle within the sac walls associated with congenital inguinal hernia. BJU Int. 2001;87(3):251–255. doi: 10.1046/j.1464-410x.2001.02028.x

[7] Sujka JA, Holcomb GW. Umbilical and other abdominal wall hernias. In: Holcomb GW, Murphy PJ, Peter SD. Holcomb and Ashcraft`s pediatric surgery. 7ed. Elsevier Science; 2020. Р. 780–782.

[8] Axer H, Keyserlingk DG, Prescher A. Collagen fibers in linea alba and rectus sheaths. I. General scheme and morphological aspects. J Surg Res. 2001;96(1):127–134. doi: 10.1006/jsre.2000.6070

[9] Lang B, Lau H, Lee F. Epigastric hernia and its etiology. Hernia. 2002;6(3):148–150. doi: 10.1007/s10029-002-0074-0

[10] Moschcowitz AV. Epigastric hernia without palpable swelling. Ann Surg. 1917;66(3):300–307. doi: 10.1097/00000658-191709000-00007

[11] Askar OM. Aponeurotic hernias. Recent observations upon paraumbilical and epigastric hernias. Surg Clin North Am. 1984;64(2):315–333. doi: 10.1016/s0039-6109(16)43288-3

[12] Korenkov M, Beckers A, Koebke J, et al. Biomechanical and morphological types of the linea alba and its possible role in the pathogenesis of midline incisional hernia. Eur J Surg. 2001;167(12):909–914. doi: 10.1080/110241501753361596

[13] Fachinelli A, Trindade MR, Fachinelli FA. Elastic fibers in the anterior abdominal wall. Hernia. 2011;15(4):409–415. doi: 10.1007/s10029-011-0804-2

[14] Dreuning K, Maat S, Twisk J, et al. Laparoscopic versus open pediatric inguinal hernia repair: State-of-the-art comparison and future perspectives from a meta-analysis. Surg Endosc. 2019;33(10):3177–3191. doi: 10.1007/s00464-019-06960-2

[15] Kumar VH, Clive J, Rosenkrantz TS, et al. Inguinal hernia in preterm infants (<or=32-week gestation). Pediatr Surg Int. 2002;18(2-3):147–152. doi: 10.1007/s003830100631

[16] Pan ML, Chang WP, Lee HC, et al. A longitudinal cohort study of incidence rates of inguinal hernia repair in 0- to 6-year-old children. J Pediatr Surg. 2013;48(11):2327–2331. doi: 10.1016/j.jpedsurg.2013.06.004

[17] Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am. 1998;45(4):773–789. doi: 10.1016/s0031-3955(05)70044-4

[18] Aboagye J, Goldstein SD, Salazar JH, et al. Age at presentation of common pediatric surgical conditions: Reexamining dogma. J Pediatr Surg. 2014;49(6):995–999. doi: 10.1016/j.jpedsurg.2014.01.039

[19] Rescorla FJ, Grosfeld JL. Inguinal hernia repair in the perinatal period and early infancy: Clinical considerations. J Pediatr Surg. 1984;19(6):832–837. doi: 10.1016/s0022-3468(84)80379-6

[20] Rowe MI, Clatworthy HW, Jr. The other side of the pediatric inguinal hernia. Surg Clin North Am. 1971;51(6):1371–1376. doi: 10.1016/s0039-6109(16)39592-5

[21] Puri P, Guiney EJ, O’Donnell B. Inguinal hernia in infants: The fate of the testis following incarceration. J Pediatr Surg. 1984;19(1):44–46. doi: 10.1016/s0022-3468(84)80013-5

[22] Stylianos S, Jacir NN, Harris BH. Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg. 1993;28(4):582–583. doi: 10.1016/0022-3468(93)90665-8

[23] Rowe MI, Clatworthy HW. Incarcerated and strangulated hernias in children. A statistical study of high-risk factors. Arch Surg. 1970;101(2):136–139. doi: 10.1001/archsurg.1970.01340260040006

[24] Miller R, Khakar A, Clarke S. Umbilical hernia in babies and children. In: LeBlanc K, Kingsnorth A, Sanders D, eds. Management of abdominal hernias. Springer, Cham; 2017. Р. 489–501. doi: 10.1007/978-3-319-63251-3_38

[25] Zens T, Nichol PF, Cartmill R, Kohler JE. Management of asymptomatic pediatric umbilical hernias: A systematic review. J Pediatr Surg. 2017;52(11):1723–1731. doi: 10.1016/j.jpedsurg.2017.07.016

[26] Vohr BR, Rosenfield AG, Oh W. Umbilical hernia in the low-birth-weight infant (less than 1,500 gm). J Pediatr. 1977;90(5):807–808. doi: 10.1016/s0022-3476(77)81257-2

[27] Smith DW, Jones KL. Abdominal wall. In: Jones KL, ed. Smith’s recognizable patterns of human malformation. 4th ed. Philadelphia: Saunders; 1988. Р. 778.

[28] Tank ES, Hatch DA. Hernias complicating chronic ambulatory peritoneal dialysis in children. J Pediatr Surg. 1986;21(1):41–42. doi: 10.1016/s0022-3468(86)80650-9

[29] Woods GE. Some observations on umbilical hernia in infants. Arch Dis Child. 1953;28(142):450–462. doi: 10.1136/adc.28.142.450

[30] Almeflh W, AlRaymoony A, AlDaaja MM, et al. A systematic review of current consensus on timing of operative repair versus spontaneous closure for asymptomatic umbilical hernias in pediatric. Med Arch. 2019;73(4):268–271. doi: 10.5455/medarh.2019.73.268-271

[31] Hall DE, Roberts KB, Charney E. Umbilical hernia: What happens after age 5 years? J Pediatr. 1981;98(3):415–417. doi: 10.1016/s0022-3476(81)80707-x

[32] Snyder CL, Escolino M, Esposito C. Inguinal hernia. In: Holcomb GW, Murphy PJ, Peter SD. Holcomb and Ashcraft`s pediatric surgery. 7ed. Elsevier Science; 2020. Р. 784–804.

[33] Parkinson EJ, Pierro A. Inguinal and umbilical hernias. In: Stringer MD, Oldham KT, Mouriquand PD, ed. Pediatric surgery and urology: Long-term outcomes. 2nd ed. Cambridge: Cambridge, University Press; 2006. P. 286–295.

[34] Hebra A, Glenn JB. Inguinal hernia and hydrocele. In: Mattei P, ed. Fundamentals of pediatric surgery. New York: Springer; 2011. P. 673–672.

[35] Doletsky SYa, Okulov AB. Inguinal hernia. Surgery.1978;(12):55–63. (In Russ.)

[36] Stalmakhovich VN, Shchebenkov MV, Songolov GI, et al. Inguinal hernia in children. Ed. by V.I. Stalmakhovich. 2nd ed., revised and updated. Irkutsk; 2013. 198 p. (In Russ.) EDN: TUBRSJ

[37] Coats RD, Helikson MA, Burd RS. Presentation and management of epigastric hernias in children. J Pediatr Surg. 2000;35(12):1754–1756. doi: 10.1053/jpsu.2000.19242

[38] Tinawi GK, Stringer MD. Epigastric hernias in children: A personal series and systematic review of the literature. Eur J Pediatr Surg. 2022;32(2):139–145. doi: 10.1055/s-0040-1719056

[39] Abdulhai SA, Glenn IC, Ponsky TA. Incarcerated pediatric hernias. Surg Clin North Am. 2017;97(1):129–145. doi: 10.1016/j.suc.2016.08.010

[40] Sameshima YT, Yamanari MG, Silva MA, et al. The challenging sonographic inguinal canal evaluation in neonates and children: An update of differential diagnoses. Pediatr Radiol. 2017;47(4):461–472. doi: 10.1007/s00247-016-3706-8

[41] Robinson A, Light D, Nice C. Meta-analysis of sonography in the diagnosis of inguinal hernias. J Ultrasound Med. 2013;32(2):339–346. doi: 10.7863/jum.2013.32.2.339

[42] Erez I, Rathause V, Vacian I, et al. Preoperative ultrasound and intraoperative findings of inguinal hernias in children: A prospective study of 642 children. J Pediatr Surg. 2002;37(6):865–868. doi: 10.1053/jpsu.2002.32889

[43] Kaneda H, Furuya T, Sugito K, et al. Preoperative ultrasonographic evaluation of the contralateral patent processus vaginalis at the level of the internal inguinal ring is useful for predicting contralateral inguinal hernias in children: A prospective analysis. Hernia. 2015;19(4):595–598. doi: 10.1007/s10029-014-1317-6

[44] Erez I, Schneider N, Glaser E, Kovalivker M. Prompt diagnosis of ‘acute groin’ conditions in infants. Eur J Radiol. 1992;15(3):185–189. doi: 10.1016/0720-048x(92)90102-f

[45] König TT, Oerters LS, Spiller L, et al. Epigastric hernias in children and the use of ultrasound in its diagnosis. World J Pediatr Surg. 2023;6(2):e000544. doi: 10.1136/wjps-2022-000544

[46] Masoudian P, Sullivan KJ, Mohamed H, Nasr A. Optimal timing for inguinal hernia repair in premature infants: A systematic review and meta-analysis. J Pediatr Surg. 2019;54(8):1539–1545. doi: 10.1016/j.jpedsurg.2018.11.002

[47] Morini F, Dreuning KM, Janssen Lok MJ, et al. Surgical management of pediatric inguinal hernia: A systematic review and guideline from the European Pediatric Surgeons’ Association Evidence and Guideline Committee. Eur J Pediatr Surg. 2022;32(3):219–232. doi: 10.1055/s-0040-1721420

[48] Glick PL, Boulanger SC. Inguinal hernias and hydroceles. In: Coran AG, Adzick NS, Krummer TM, et al., eds. Pediatric surgery. 7th ed. Philadelphia: WB Saunders Elsevier; 2012. Р. 985–1001.

[49] Gahukamble DB, Khamage AS. Early versus delayed repair of reduced incarcerated inguinal hernias in the pediatric population. J Pediatr Surg. 1996;31(9):1218–1220. doi: 10.1016/s0022-3468(96)90235-3

[50] Grosfeld JL. Current concepts in inguinal hernia in infants and children. World J Surg. 1989;13(5):506–515. doi: 10.1007/BF01658863

[51] Davies N, Najmaldin A, Burge DM. Irreducible inguinal hernia in children below two years of age. Br J Surg. 1990;77(11):1291–1292. doi: 10.1002/bjs.1800771131

[52] Niedzielski J, Kr R, Gawłowska A. Could incarceration of inguinal hernia in children be prevented? Med Sci Monit. 2003;9(1):CR16-8.

[53] Vaos G, Gardikis S, Kambouri K, et al. Optimal timing for repair of an inguinal hernia in premature infants. Pediatr Surg Int. 2010;26(4):379–385. doi: 10.1007/s00383-010-2573-x

[54] Shchebenkov MV. Endovideosurgical treatment of children with pathology of the vaginal process of the peritoneum. Russian Journal of Pediatric Surgery. 2002;(4):24. (In Russ.)

[55] Zendejas B, Kuchena A, Onkendi EO, et al. Fifty-three-year experience with pediatric umbilical hernia repairs. J Pediatr Surg. 2011;46(11):2151–2156. doi: 10.1016/j.jpedsurg.2011.06.014

[56] Lassaletta L, Fonkalsrud EW, Tovar JA. The management of umbilicial hernias in infancy and childhood. J Pediatr Surg. 1975;10(3):405–409. doi: 10.1016/0022-3468(75)90104-9

[57] Sugimoto T, Tahara K, Uchida K, Yoshimoto K. Efficacy of adhesive strapping on umbilical hernia in children: A systematic review and meta-analysis of cohort studies. World J Pediatr Surg. 2023;6(4):e000633. doi: 10.1136/wjps-2023-000633

[58] Chirdan LB, Uba AF, Kidmas AT. Incarcerated umbilical hernia in children. Eur J Pediatr Surg. 2006;16(1):45–48. doi: 10.1055/s-2006-923792

[59] Dobrokvashin SV, Volkov DE. Perioperative antibioticoprophylaxis in surgery. Kazan medical journal. 2004;85(5):323–327. EDN: HRMKJJ

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