Przepuklina pępkowa – Epidemiologia

Przepuklina pępkowa
Epidemiologia

Przepuklina pępkowa (hernia umbilicalis) jest drugim co do częstości występowania typem przepukliny brzusznej, stanowiąc 6-14% wszystkich przepuklin u dorosłych oraz 10-30% u noworodków, z wyższą częstością u wcześniaków (do 84% przy masie 1000-1500 g) i dzieci afroamerykańskich (26,6%). U dzieci częstość występowania maleje do 2-10% w wieku 1 roku, a około 80-85% przepuklin zamyka się samoistnie do 5 roku życia. U dorosłych przepuklina pępkowa jest głównie schorzeniem nabytym, częściej występującym u kobiet (3-10 razy częściej niż u mężczyzn), zwłaszcza w wieku 31-40 lat, z częstością występowania 10-25%. Czynniki ryzyka obejmują otyłość, wielokrotne ciąże, wodobrzusze, podnoszenie ciężarów, przewlekły kaszel oraz osłabienie mięśni ściany brzucha. W populacjach z marskością wątroby częstość przepukliny pępkowej wynosi około 20%.

Epidemiologia przepukliny pępkowej

Częstotliwość występowania u dzieci
Różnice płciowe i wiekowe
Przepuklina pępkowa u dorosłych
Czynniki ryzyka

Zróżnicowanie geograficzne i etniczne w występowaniu przepukliny pępkowej

Globalne obciążenie przepuklinami brzusznymi

Przepuklina pępkowa jako obciążenie dla systemów opieki zdrowotnej

Chorobowość i śmiertelność

Metody diagnostyczne i nadzór nad przepukliną pępkową

Nadzór i postępowanie terapeutyczne
Znaczenie wytycznych i badań epidemiologicznych
Kolejne rozdziały

Epidemiologia przepukliny pępkowej

Przepuklina pępkowa (łac. hernia umbilicalis) stanowi jeden z najczęstszych typów przepuklin brzusznych i jest drugim co do częstości występowania rodzajem przepukliny po przepuklinie pachwinowej. Przepukliny pępkowe stanowią około 6-14% wszystkich przepuklin brzusznych u dorosłych.¹² Jest to schorzenie stosunkowo powszechne, dotykające zarówno dzieci jak i dorosłych, z wyraźnie zróżnicowaną epidemiologią w zależności od wieku, płci i pochodzenia etnicznego.

Częstotliwość występowania u dzieci

Przepuklina pępkowa należy do najczęstszych schorzeń chirurgicznych u dzieci. Szacuje się, że występuje ona u około 10-30% wszystkich noworodków, przy czym najwyższe wskaźniki odnotowuje się w kilku konkretnych grupach:¹²³

U około 15-23% noworodków (około 800 000 noworodków rocznie w Stanach Zjednoczonych)¹
Znacznie częściej u wcześniaków i dzieci z niską masą urodzeniową – nawet do 84% u noworodków o wadze 1000-1500 g¹
Do 20,5% u niemowląt ważących przy urodzeniu 2000-2500 g¹
Szczególnie często u dzieci pochodzenia afroamerykańskiego, z częstością występowania sięgającą 26,6%¹²

Z wiekiem częstość występowania przepuklin pępkowych u dzieci zmniejsza się – do około 2-10% w wieku 1 roku życia.¹ Istotne jest, że większość przepuklin pępkowych u dzieci zamyka się samoistnie – około 80-85% do 5 roku życia, bez konieczności interwencji chirurgicznej.¹²

Różnice płciowe i wiekowe

Epidemiologia przepukliny pępkowej wykazuje wyraźne różnice w zależności od płci i wieku:¹²

U dzieci przepuklina pępkowa występuje z podobną częstością u chłopców i dziewczynek – nie zaobserwowano istotnych różnic płciowych¹²
U dorosłych przepuklina pępkowa jest około 3 razy częstsza u kobiet niż u mężczyzn, co przypisuje się głównie wpływowi ciąży i porodu, a także zwiększonej częstości występowania otyłości¹²³
Niektóre źródła wskazują nawet na 10 razy wyższą częstość występowania u kobiet¹
Szczyt zachorowań u kobiet przypada na wiek 31-40 lat, natomiast u mężczyzn na wiek 61-70 lat¹
Najwyższą 5-letnią częstość przepuklin pępkowych poddawanych zabiegom chirurgicznym zaobserwowano u mężczyzn w wieku 60-70 lat (0,53%)¹

Przepuklina pępkowa u dorosłych

Przepuklina pępkowa u dorosłych najczęściej jest schorzeniem nabytym – prawie 90% przepuklin pępkowych u dorosłych nie ma swojego początku w dzieciństwie.¹ Ogólna częstość występowania przepuklin pępkowych u dorosłych waha się między 2% a 50%, w zależności od badanej populacji:¹²³

Według różnych źródeł częstość występowania przepuklin pępkowych u dorosłych mieści się w przedziale 10-25%¹
U pacjentów z marskością wątroby częstość występowania przepukliny pępkowej wynosi około 20%, co jest wyższe niż w populacji ogólnej¹²
Przepuklina pępkowa stanowi około 10% wszystkich przepuklin brzusznych u dorosłych¹

Czynniki ryzyka

Zidentyfikowano kilka istotnych czynników ryzyka rozwoju przepukliny pępkowej:¹²

U dzieci: wcześniactwo, niska masa urodzeniowa, pochodzenie afroamerykańskie lub latynoskie¹²
U dorosłych: otyłość, wielokrotne ciąże, wodobrzusze, duże guzy brzuszne¹²
Zwiększone ciśnienie wewnątrzbrzuszne spowodowane: podnoszeniem ciężkich przedmiotów, przewlekłym kaszlem, trudnościami z wypróżnianiem lub oddawaniem moczu¹
Osłabienie mięśni ściany brzucha związane z wiekiem¹

Zróżnicowanie geograficzne i etniczne w występowaniu przepukliny pępkowej

Występowanie przepukliny pępkowej wykazuje znaczące różnice w zależności od pochodzenia etnicznego i regionu geograficznego. Szczególnie wyraźne różnice zaobserwowano w populacjach pediatrycznych:¹²

U dzieci afroamerykańskich przepuklina pępkowa występuje około 8 razy częściej niż u dzieci rasy białej¹
Badania prowadzone w populacjach afrykańskich wykazały, że aż 23% dzieci miało rzeczywiste przepukliny pępkowe¹
Podobne zwiększone ryzyko obserwuje się u dzieci pochodzenia latynoskiego¹

Dostępne dane sugerują wyższą częstość występowania przepuklin w Afryce w porównaniu z Europą i Ameryką Północną. W krajach o niskim i średnim dochodzie przepukliny stanowią istotny problem zdrowotny, przyczyniając się do znacznej śmiertelności i niepełnosprawności.¹²

Globalne obciążenie przepuklinami brzusznymi

Globalne dane dotyczące obciążenia przepuklinami brzusznymi, w tym przepuklinami pępkowymi, wskazują na znaczne różnice regionalne:¹²

W 2019 roku na całym świecie odnotowano 32,53 miliona przypadków przepuklin pachwinowych, udowych i brzusznych¹
Liczba nowych przypadków wyniosła 13,02 miliona, co stanowi wzrost o 63,67% w porównaniu z 1990 rokiem¹
Największe obciążenie przepuklinami występuje w Azji, gdzie Azja Południowa, Wschodnia i Południowo-Wschodnia odpowiadają za około połowę światowych przypadków¹
Największy wzrost liczby nowych przypadków odnotowano w regionach o niskim wskaźniku rozwoju społecznego, szczególnie w Środkowej Afryce Subsaharyjskiej¹

Przepuklina pępkowa jako obciążenie dla systemów opieki zdrowotnej

Przepuklina pępkowa stanowi znaczące obciążenie dla systemów opieki zdrowotnej na całym świecie, zarówno pod względem liczby przeprowadzanych operacji, jak i związanych z nimi kosztów:¹²

Rocznie na świecie przeprowadza się około 20 milionów operacji przepuklin pępkowych¹
W samych Stanach Zjednoczonych wykonuje się około 175 000 operacji przepuklin pępkowych rocznie¹²
W Wielkiej Brytanii średni czas oczekiwania na operację przepukliny wzrósł do prawie 104 dni w latach 2010-2015¹

Badania kosztowe wskazują na różnice w wydatkach związanych z różnymi strategiami leczenia przepuklin pępkowych:¹²

Grupa pacjentów poddanych leczeniu chirurgicznemu (zarówno metodą otwartą, jak i laparoskopową) wykazywała wyższe koszty po 90 i 365 dniach niż grupa nieleczona chirurgicznie¹
Jednak grupa nieleczona chirurgicznie miała znacznie wyższe wykorzystanie opieki zdrowotnej i szacowaną liczbę dni nieobecności w pracy, co sugeruje, że wczesna interwencja zmniejsza koszty i wykorzystanie zasobów¹

Chorobowość i śmiertelność

Przepuklina pępkowa wiąże się z różnym ryzykiem powikłań w zależności od wieku pacjenta:¹²

U dzieci powikłania takie jak uwięźnięcie, zadzierzgnięcie i pęknięcie są rzadkie – ryzyko uwięźnięcia szacuje się na mniej niż 1% (0,2-4,5%)¹²
Ryzyko uwięźnięcia jest około 2 razy wyższe u wcześniaków¹
U dorosłych ryzyko powikłań jest wyższe, a uwięźnięcie i zadzierzgnięcie przepukliny pępkowej może wymagać pilnej interwencji chirurgicznej¹²
Szczególnie wysokie ryzyko powikłań występuje u pacjentów z marskością wątroby i wodobrzuszem¹

Wyniki chirurgicznego leczenia przepuklin pępkowych są zazwyczaj dobre:¹²

Ryzyko nawrotu po operacji wynosi około 1-3%¹
Powikłania pooperacyjne, takie jak zakażenie rany, są rzadkie¹
Częstość nawrotów wydaje się być wyższa u dzieci operowanych w młodszym wieku (poniżej 4 lat)¹

Metody diagnostyczne i nadzór nad przepukliną pępkową

Diagnoza przepukliny pępkowej opiera się głównie na badaniu fizykalnym, chociaż w niektórych przypadkach mogą być potrzebne dodatkowe badania obrazowe:¹²

Przepuklina pępkowa jest najczęściej rozpoznawana na podstawie badania fizykalnego brzucha, z uwypukleniem w okolicy pępka¹²
Obrazowanie (USG lub tomografia komputerowa) ma istotną rolę w ostatecznej diagnozie, szczególnie gdy defekt jest mały lub tkanka tłuszczowa brzucha jest znaczna¹
Wiele przepuklin można wykryć tylko za pomocą badań obrazowych¹
U dorosłych przepukliny pępkowe są często bezobjawowe, a najczęstszymi powodami konsultacji są ból i dyskomfort estetyczny¹

Nadzór i postępowanie terapeutyczne

Strategie nadzoru i leczenia przepukliny pępkowej różnią się w zależności od wieku pacjenta:¹²

U dzieci zaleca się obserwację do około 4-5 roku życia, ponieważ większość przepuklin pępkowych zamyka się samoistnie¹²
Czynniki takie jak wcześniactwo i zwiększająca się wielkość ubytku powinny być brane pod uwagę podczas monitorowania dzieci z przepukliną pępkową¹
U dorosłych przepukliny pępkowe najczęściej wymagają leczenia chirurgicznego, ponieważ mało prawdopodobne jest, aby stan ten poprawił się samoistnie, a ryzyko powikłań jest wyższe¹²
Badania wskazują, że nawet małe przepukliny postępują w czasie, dlatego wczesna naprawa może być korzystna¹

Pomimo postępów w zakresie różnych typów siatek i chirurgii małoinwazyjnej (laparoskopowej i robotycznej), nadal nie ma prawdziwego konsensusu co do optymalnej metody naprawy przepukliny pępkowej. Na podstawie charakterystyki pacjenta i kontekstu, zawsze należy stosować „dostosowaną i zoptymalizowaną chirurgię”, aby uzyskać najlepsze wyniki.¹

Znaczenie wytycznych i badań epidemiologicznych

Badania epidemiologiczne zwracają uwagę na znaczenie opracowania formalnych, opartych na konsensusie wytycznych dotyczących najlepszych praktyk w leczeniu przepuklin pępkowych. Takie wytyczne pomogłyby lekarzom podstawowej opieki zdrowotnej, pediatrom i chirurgom w ustaleniu bardziej zrównoważonego podejścia, uwzględniającego ryzyko związane z wczesną operacją u bardzo małych dzieci oraz potencjalne powikłania wynikające z nienaprawionych przepuklin.¹

Przyszłe badania na dużą skalę, analizujące różne kategorie pacjentów o różnych profilach ryzyka, są niezbędne do lepszego zrozumienia epidemiologii przepukliny pępkowej i optymalizacji strategii leczenia.¹

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Materiały źródłowe

#1 Umbilical Hernia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459312/
An umbilical hernia is a defect in the ventral abdominal fascia at or near the umbilicus. The umbilicus is a frequent site of hernia, and umbilical hernias are often diagnosed during routine physical examinations. […] Umbilical hernias account for 6% to 14% of all adult abdominal wall hernias and are second in frequency only to inguinal hernias. […] The overall incidence of umbilical hernias in adults is between 23% and 50%. The prevalence of umbilical hernias peaks between ages 31 to 40 in women and between ages 61 to 70 in men. Umbilical hernias are three times more common in women due to the effects of pregnancy and childbirth, as well as the increased incidence of obesity. […] Approximately 175,000 umbilical hernia repairs are performed annually in the United States, and 20 million are performed globally.
#1 Pediatric Umbilical Hernia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459294/
Umbilical hernias are a prevalent condition among children. It is estimated that approximately 15%-23% of all newborns (approximately 800,000 neonates per year in the United States) have umbilical hernias. However, this percentage gradually decreases to 2%-10% by the time the child attains the age of 1 year. Umbilical hernias affect both boys and girls equally, with no significant gender-based differences in occurrence. The underlying reasons for the higher occurrence of umbilical hernias in the African-American infant population, with reported incidence rates as high as 26.6%, are not yet well understood. Pediatric umbilical hernias are significantly more prevalent in premature and low-birth-weight infants compared to neonates with normal maturity and weight. The incidence of pediatric umbilical hernias can be as high as 84% in newborn infants weighing between 1,000 and 1,500 grams, whereas it decreases to 20.5% in infants weighing between 2,000 and 2,500 grams at birth.
#1 Abdominal Hernias: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/189563-overview
As much as 10% of the population develops some type of hernia during life. More than 1 million abdominal hernia repairs are performed each year, with inguinal hernia repairs constituting nearly 770,000 of these cases. Frequencies of various types of hernias are as follows: Approximately 75% of all hernias are inguinal; of these, 50% are indirect (male-to-female ratio, 7:1), with a right-side predominance, and 25% are direct; 3% of inguinal hernias have a sliding component, most often on the left side (left-to-right ratio, 4.5:1) […] About 14% of hernias are umbilical […] The prevalence of all varieties of hernias increases with age. Umbilical hernias occur in approximately one of every six children. They usually develop in infants and reach their maximal size by the first month of life. Most hernias of this type close spontaneously by the first year of life; the incidence in children older than 1 year is only 2-10%. Umbilical hernias are much more common in persons of African ethnicity. With respect to the pediatric population, umbilical hernias occur eight times more frequently in black infants than in white infants.
#1 Avoid referring most children with umbilical hernias to a pediatric surgeon until around age four to five years. | AAFP
https://www.aafp.org/pubs/afp/collections/choosing-wisely/417.html
Patients with umbilical hernias may safely be observed until at least age four years; at that point, pediatric surgical consultation is recommended to discuss surgical repair option. Umbilical hernias, resulting from failure of complete closure of the umbilical ring after birth, affect up to 25% of newborns. […] A majority of newborn umbilical hernias will close spontaneously about 85% closure rate by age five years. […] Complications of umbilical hernia, such as incarceration (where omentum or bowel is stuck in the hernia sac, estimated at 0.2% to 4.5%) or strangulation (where omentum or bowel is incarcerated and proceeds to suffer ischemic damage, estimated at less than 0.8%) are very rare; thus, the risk/benefit ratio in surgical closure of umbilical hernias strongly favors observation. […] Complications following umbilical hernia repair in children are rare and may include infection (estimated at less than 1%) and recurrence (estimates ranging from 0.27% to 2.44%). Recurrence rates appear to be higher in children repaired at an early age (less than four years).
#1 Umbilical hernia | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/umbilical-hernia?embed_domain=external.radpair.com%252527%25255b0%25255dfavicon.icofavicon.ico&lang=gb
Umbilical hernias are the most common ventral abdominal wall hernia and occur in the midline through the umbilicus. […] Ten times more common in females and represent ~5% of all abdominal hernias.
#1 The prevalence of umbilical and epigastric hernia repair: a nationwide epidemiologic study | CoLab
https://colab.ws/articles/10.1007%2Fs10029-015-1376-3
Surgery Umbilical and epigastric hernia repair are common surgical procedures; however, the nationwide gender and age-specific prevalence of these repairs is unknown, and this knowledge could form the basis for new studies. A nationwide register-based study covering all people living in Denmark on December 31st, 2010 was performed. Within this population all umbilical and epigastric hernia repairs from January 1st, 2006 to December 31st, 2010 were identified using data from the Danish National Hospital Register, and 5-year prevalence estimates were calculated. The study population covered 5,639,885 persons (49 % males). A total of 10,107 patients (68 % males) were operated for an umbilical hernia and 2412 patients (55 % males) were operated for an epigastric hernia. The age-specific 5-year prevalence differed for both hernia types. The highest 5-year prevalence of umbilical hernia repairs was seen in males aged 6070 years with a 5-year prevalence of 0.53 % (95 % CI 0.510.56 %) and the highest age-specific 5-year prevalence of epigastric hernia repair was seen in 4050 year females with a 5-year prevalence of 0.086 % (95 % CI 0.0770.095 %). The gender and age-specific 5-year prevalence of umbilical and epigastric hernia repair differed in a nationwide population.
#1 Umbilical Hernias in Adults: Epidemiology, Diagnosis and Treatment | IntechOpen
https://www.intechopen.com/chapters/73959
The literature on umbilical hernias in adults remains less extensive compared to other types of hernias. […] Umbilical hernia is the second most frequent type of hernia and accounts for 614% of all abdominal wall hernias in adults, after inguinal hernias. […] However, in adults, nearly 90% of umbilical hernias are acquired with no indication of hernia in childhood. […] The risk factors are the same as for other abdominal wall hernias and are caused predominantly by intra-abdominal hyper pressure and/or parietal weakness. […] A female predominance is however noted with a sex ratio of 3:1. […] The diagnosis of umbilical hernia is most often evident on physical examination of the abdomen with tumefaction in the umbilicus. […] Imaging has an important role in the definitive diagnosis. […] Indeed, many hernias are only detectable on imaging (ultrasound or computed tomography) especially when the defect is small or the abdominal fat tissue is important. […] Umbilical hernia remains a relatively common disease in adults.
#1 Umbilical hernia: when and how – Maia – Annals of Laparoscopic and Endoscopic Surgery
https://ales.amegroups.org/article/view/5123/html
The incidence of umbilical hernias in adults ranges from 10% to 25% in the literature and is increased in females. […] Some predisposing factors for umbilical hernia development include pregnancy, obesity, ascites and large abdominal tumors leading to increased abdominal pressure. […] Approximately 175,000 umbilical hernias are surgically repaired annually in US. […] According to the National Health System in UK, the average waiting time for hernia surgery increased to almost 104 days, from year 2010 to 2015. […] In a cohort study encompassing 3,000 hospitals and 279 employers in the United States, two groups were evaluated for the cost of watchful waiting as a strategy in patients with umbilical hernia. […] Surgical group (open and laparoscopic approach) showed higher costs at 90 and 365 days than the non-surgical group.
#1 Umbilical hernia: when and how – Maia – Annals of Laparoscopic and Endoscopic Surgery
https://ales.amegroups.org/article/view/5123/html
However, non-surgical group had a significantly higher utilization of healthcare and estimated days off work than the surgical group, concluding that early intervention decreases costs and resource utilization. […] The incidence of umbilical hernias in cirrhotic patients is approximately 20%, higher than in the general population and occurs more on males than in females. […] Umbilical hernia repair in a cirrhotic patient with ascites is a very challenging scenario. […] The most conventional approach to emergency umbilical hernia is the open hernia repair, especially if the patients are premorbidly unwell, be it with or without bowel resections. […] However, the laparoscopic approach is acceptable and may even be preferred when the patient is obese or when the presentation is early especially if there are no bowel resections required.
#1 Abdominal hernias – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/abdominal-hernias/
Umbilical hernias are defined as midline hernias at the level of the umbilicus. Ninety percent of umbilical hernias are acquired, usually as a result of increased abdominal pressure. […] Epidemiology: 10-20% of infants born at term have a congenital hernia. […] 10% of all adult abdominal hernias are acquired umbilical hernias. […] Up to 20% of patients with cirrhosis develop an umbilical hernia.
#1 Umbilical Hernia Surgery – University Surgeons Associates
http://www.utsurgery.com/spec_hernia_umbilical.php
Both men and women can get an umbilical hernia. […] Complications of umbilical hernias such as incarceration, obstruction and strangulation do occur but at a very low rate. […] Anyone can develop an umbilical hernia at any age. […] Most umbilical hernias in children are congenital and close spontaneously by the age of two. […] In adults, a natural weakness or strain from heavy lifting, persistent coughing, difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate. […] When the surgery has been done laparoscopically, it is common for fluid to collect in the old hernia sac. This is called a seroma and usually resolves over time.
#1 Adult Umbilical Hernia | ACS
https://www.facs.org/for-patients/the-day-of-your-surgery/adult-umbilical-hernia/
Ten percent of all hernias in adults are umbilical. They are three times more common in women due to pregnancy. They are equally as common in men and women over 60 years as abdominal muscles start to weaken. […] Hernia among pregnancies is 0.08%. If the hernia is not complicated, but symptomatic, it should be repaired. If the hernia is incarcerated or strangulated it will require an emergency repair. […] Umbilical hernias are usually diagnosed by clinical examination only. Imaging by ultrasound or CT scan can be considered if clinical examination is unsure.
#1 Umbilical hernia – Wikipedia
https://en.wikipedia.org/wiki/Umbilical_hernia
Umbilical hernias are common. With a study involving Africans, 92% of children had protrusions, 49% of adults, and 90% of pregnant women. However, a much smaller number actually had hernias: only 23% of children, 8% of adults, and 15% of pregnant women. […] Among adults, it is three times more common in women than in men; among children, the ratio is roughly equal. It is also found to be more common in children of African descent. […] An acquired umbilical hernia directly results from increased intra-abdominal pressure caused by obesity, heavy lifting, a long history of coughing, or multiple pregnancies.
#1 Umbilical hernia epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Umbilical_hernia_epidemiology_and_demographics
The prevalence of umbilical hernia is approximately 0.015 to 0.023 per 100,000 of newborns affected in USA. Commonly seen in low-birth-weight babies, African-Americans, and Hispanics. It affects males and females equally. […] The epidemiology and demographics are as follows: […] The prevalence of umbilical hernia is approximately 0.015 to 0.023 per 100,000 of newborns affected in USA. […] Patients of all age groups may develop umbilical hernia. […] Umbilical hernia usually affects individuals of the African-American race and Hispanic race. […] White individuals are less likely to develop Umbilical hernia. […] Umbilical hernia affects men and women equally.
#1 Frequency of Abdominal Wall Hernias: A Nigerian Hospital Experience
https://www.ej-med.org/index.php/ejmed/article/view/1673
External abdominal wall hernias constitute an enduring healthcare burden all over the world. […] There are variations in the prevalence in different countries but limited data suggest a higher hernia prevalence in Africa compared to Europe and North America. […] Moreover, more recent estimates from the Global Burden of Disease Study suggest a global annual mortality of 44,200 in addition to disability-adjusted life years (DALY) rate of 43.5 per 100,000. […] A large portion of this burden is attributed to low-middle-income countries where the high prevalence of hernias does not translate to a correspondingly large volume of these hernias being operated upon. […] The incidence of abdominal wall hernia is not precisely known, however, it occurs in about 1.7% of the population. […] Inguinal hernia account for 75% of these hernias.
#1
https://journals.lww.com/international-journal-of-surgery/fulltext/2023/03000/the_global,_regional,_and_national_burden_and_its.18.aspx
Globally, there were 32.53 million [95% uncertainty interval (UI): 27.7137.79] prevalent cases and 13.02 million (10.6815.49) incident cases of inguinal, femoral, and abdominal hernias in 2019, which increased by 36.00% and 63.67%, respectively, compared with 1990. […] From 1990 to 2019, the ASIR and ASPR showed a decreasing trend worldwide, except in Central Sub-Saharan Africa, which had an increasing trend in ASIR and ASPR. […] The global incident cases and prevalent cases of inguinal, femoral, and abdominal hernias increased substantially from 1990 to 2019, with a heavier burden observed in males, older adults, and in LMICs such as India and China. […] The ASIR exhibited an increasing trend among females but decreased among males. […] The burden of inguinal, femoral, and abdominal hernias was highest among individuals who were middle-aged and older, consistent with previous studies that have reported that the risk of inguinal hernia increases with age.
#1
https://journals.lww.com/international-journal-of-surgery/fulltext/2023/03000/the_global,_regional,_and_national_burden_and_its.18.aspx
The incident cases were highest among individuals aged 5069 years. […] The incident cases increased the most in the low SDI region, with the largest absolute increase occurring in Central Sub-Saharan Africa. […] In this study, the burden of inguinal, femoral, and abdominal hernias was greatest in Asia. Notably, South Asia, East Asia, and Southeast Asia accounted for approximately half of the worldwide incident cases. […] The ASIR exhibited a decreasing trend in South Asia, consistent with the trend worldwide. […] The need for hernia management has become an important socioeconomic problem and may affect healthcare systems worldwide, especially in China and India. […] Thus, more efforts are needed to increase access to safe hernia repair and to reduce the burden of inguinal, femoral, and abdominal hernias in limited-resource settings.
#1 Umbilical hernia – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/umbilical-hernia/symptoms-causes/syc-20378685
Umbilical hernias are common and typically harmless. […] Umbilical hernias are most common in infants, but they can affect adults as well. […] Umbilical hernias that appear during adulthood are more likely to need surgical repair. […] Umbilical hernias are most common in infants especially premature babies and those with low birth weights. […] For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. […] Adults with umbilical hernias are somewhat more likely to experience a blockage of the intestines. Emergency surgery is typically required to treat these complications.
#1 Pediatric Umbilical Hernia | ACS
https://www.facs.org/for-patients/the-day-of-your-surgery/pediatric-umbilical-hernia/
Umbilical hernias are one of the most common conditions in children. They occur equally among boys and girls and in 15 to 23% of newborns. They are very common in African-American, Hispanic and low birth-weight infants. […] The risk of incarceration of umbilical hernia in children is rare (less than 1 in 100) but premature infants have 2x the risk. More than 2/3 of incarcerations occur before age 1 year. […] Watchful waiting is recommended for children who have no symptoms. In 95% of cases, umbilical hernias less than 1 cm in diameter close on their own within 5 years of age. After age 5, repair is recommended. […] Both incarceration and strangulation requiring emergency surgery occur in less than 1 in 100 children with umbilical hernias. Surgical outcome is good in children, even with incarcerated or strangulated hernias, as long as fluid and electrolyte balance is corrected and the hernia is repaired quickly.
#1 Umbilical Hernias: Guide to Symptoms & Treatment | Columbia Surgery
https://columbiasurgery.org/conditions-and-treatments/umbilical-hernias-guide-symptoms-treatment
Up to 2% of the adult population has an umbilical hernia, and is more common in those who are overweight, had multiple pregnancies, or with liver cirrhosis. […] Even though some smaller hernias without symptoms can be watched over time, most research shows that even small hernias progress over time, therefore repairing them early may be beneficial. […] All laparoscopic/robotic repairs involve the use of mesh reinforcement, as this has been shown to reduce the risk of recurrence in larger hernias. […] Complications of umbilical hernia repair are rare, and include but are not limited to: Hernia recurrence (1-3%). […] Your doctor typically will want to see you back for a 2-3 week follow up appointment.
#1 Umbilical Hernias in Adults: Epidemiology, Diagnosis and Treatment
https://ouci.dntb.gov.ua/en/works/4EgJDo09/
The literature on umbilical hernias in adults remains less extensive compared to other types of hernias. […] Adult umbilical hernias are frequently asymptomatic. […] The most frequent reasons for consultation are pain and esthetic discomfort. […] The diagnosis is most often evident on physical examination of the abdomen with tumefaction in the umbilicus. […] Despite the recent advances in terms of mesh varieties and minimally invasive surgery (laparoscopic and robotic surgery), there is still no real consensus on the optimal method for repair of umbilical hernia. […] Based on the patient characteristics and the context, âtailored and optimized surgeryâ should always be used to have the best results.
#1 Pediatric Umbilical Hernia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459294/
The findings highlight the significant disparities in surgical patterns for pediatric umbilical hernias. They underscore the importance of developing national, formal, and consensus-based best practice guidelines. Such guidelines would assist primary care physicians, pediatricians, and surgeons in establishing a more balanced approach, considering the risks associated with early surgery in very young children and the potential complications arising from unrepaired hernias.
#1 Predictors of spontaneous resolution of umbilical hernia in children | World Journal of Pediatric Surgery
https://wjps.bmj.com/content/4/3/e000287
Pediatric umbilical hernias are common, affecting approximately 10%30% of live births. […] There is minimal evidence on factors affecting the likelihood of spontaneous resolution in children. […] The probability of spontaneous resolution is lower for premature babies. […] The probability of spontaneous resolution is negatively correlated with the defect size when adjusting for prematurity and other comorbidities. […] The odds of spontaneous resolution were lower for premature babies and were negatively correlated with defect size. […] Factors such as prematurity and increasing defect size should continue to be considered during the management of children with umbilical hernia. […] Overall, conservative management is justifiable and appropriate during pediatric monitoring of asymptomatic umbilical hernia.
#1
https://www.nhs.uk/conditions/umbilical-hernia-repair/
Umbilical hernias are very common in infants and young children, particularly in babies born prematurely. […] Umbilical hernias can also develop in adults. Without treatment, the hernia will probably get worse over time. […] Surgery is recommended for most adults with an umbilical hernia because the hernia is unlikely to get better by itself when you’re older and the risk of complications is higher.
#1 Frontiers Publishing Partnerships | Long-Term Outcomes After Epigastric Hernia Repair in WomenâA Nationwide Database Study
https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2023.11626/full
The higher risk of recurrence after sutured repair compared with mesh repair may be on the expense of a slightly higher risk of wound complications. […] Surgical societies recommend using a mesh-based repair to reduce recurrence rate, and to choose a minimally invasive approach to decrease the risk of surgical site infection. […] Future large-scaled studies investigating different patient categories with different risk patterns are warranted.
#2 Umbilical Hernias in Adults: Epidemiology, Diagnosis and Treatment | IntechOpen
https://www.intechopen.com/chapters/73959
The literature on umbilical hernias in adults remains less extensive compared to other types of hernias. […] Umbilical hernia is the second most frequent type of hernia and accounts for 614% of all abdominal wall hernias in adults, after inguinal hernias. […] However, in adults, nearly 90% of umbilical hernias are acquired with no indication of hernia in childhood. […] The risk factors are the same as for other abdominal wall hernias and are caused predominantly by intra-abdominal hyper pressure and/or parietal weakness. […] A female predominance is however noted with a sex ratio of 3:1. […] The diagnosis of umbilical hernia is most often evident on physical examination of the abdomen with tumefaction in the umbilicus. […] Imaging has an important role in the definitive diagnosis. […] Indeed, many hernias are only detectable on imaging (ultrasound or computed tomography) especially when the defect is small or the abdominal fat tissue is important. […] Umbilical hernia remains a relatively common disease in adults.
#2 Umbilical Hernia | Children’s Hospital of Philadelphia
https://www.chop.edu/conditions-diseases/umbilical-hernia
It is estimated that umbilical hernias occur in 10-15 percent of all infants, with boys and girls affected equally. […] African Americans, low birth weight and premature infants are at a greater risk for having an umbilical hernia. […] The diagnosis of an umbilical hernia is confirmed by a thorough health history and physical examination. […] Imaging studies are almost never needed to diagnose umbilical hernias.
#2 Umbilical hernia: Causes, symptoms, and treatments
https://www.medicalnewstoday.com/articles/189580
Umbilical hernias are the second most common form of hernia in adults. They occur within 3 centimeters (cm) of a persons navel either above or below it. […] Umbilical hernias are common in infants. They are present in approximately 10-30% of white children at birth, while various studies have shown a prevalence of 23-85% in African American children at birth. […] The major risk factors for umbilical hernias are: Age: Infants, especially those born preterm, have a higher risk of an umbilical hernia than adults. […] Most umbilical hernias in adults result from extra pressure on the abdominal wall. This extra pressure may come from carrying multiple pregnancies or straining intensely. […] There is a higher risk of complications in adult umbilical hernias, and these almost always require surgery to correct.
#2 Umbilical Hernia – BetterKids
https://betterkids.com.au/conditions/umbilical-hernia/
An umbilical hernia is a lump of the belly button (umbilicus), caused by a small opening in the abdominal wall where the umbilical cord passed through. This opening allows fat or intestines to bulge out, forming a noticeable lump. Umbilical hernias are quite common in infants and often resolve without treatment during the first year of life. […] In most cases, umbilical hernias do not require surgery. Over 90% of umbilical hernias close on their own within 5 years. Even in older children the defect in the abdominal muscles often continues to close with age. […] Umbilical hernias are a common condition in babies and generally resolve without intervention. In the vast majority of cases, no surgery is required. Parents should keep an eye on the hernia, but thereâs usually no need for concern. If you notice any worrying symptoms, consult your doctor for further advice.
#2
https://link.springer.com/article/10.1007/BF01194437
Umbilical hernia has not received as much attention as other abdominal wall defects. Prevalence in the adult population is 2% and is much more common in cirrhotic patients and obese middle-aged multiparous women. […] The high morbidity and mortality associated with incarcerated umbilical hernias demand an elective repair in all circumstances. […] Control studies with long follow-up are now required in order to establish evidence based umbilical surgery.
#2 Abdominal hernias – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/abdominal-hernias/
Umbilical hernias are defined as midline hernias at the level of the umbilicus. Ninety percent of umbilical hernias are acquired, usually as a result of increased abdominal pressure. […] Epidemiology: 10-20% of infants born at term have a congenital hernia. […] 10% of all adult abdominal hernias are acquired umbilical hernias. […] Up to 20% of patients with cirrhosis develop an umbilical hernia.
#2 Umbilical hernia: when and how – Maia – Annals of Laparoscopic and Endoscopic Surgery
https://ales.amegroups.org/article/view/5123/html
The incidence of umbilical hernias in adults ranges from 10% to 25% in the literature and is increased in females. […] Some predisposing factors for umbilical hernia development include pregnancy, obesity, ascites and large abdominal tumors leading to increased abdominal pressure. […] Approximately 175,000 umbilical hernias are surgically repaired annually in US. […] According to the National Health System in UK, the average waiting time for hernia surgery increased to almost 104 days, from year 2010 to 2015. […] In a cohort study encompassing 3,000 hospitals and 279 employers in the United States, two groups were evaluated for the cost of watchful waiting as a strategy in patients with umbilical hernia. […] Surgical group (open and laparoscopic approach) showed higher costs at 90 and 365 days than the non-surgical group.
#2 Umbilical hernia – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/umbilical-hernia/symptoms-causes/syc-20378685
Umbilical hernias are common and typically harmless. […] Umbilical hernias are most common in infants, but they can affect adults as well. […] Umbilical hernias that appear during adulthood are more likely to need surgical repair. […] Umbilical hernias are most common in infants especially premature babies and those with low birth weights. […] For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia. […] Adults with umbilical hernias are somewhat more likely to experience a blockage of the intestines. Emergency surgery is typically required to treat these complications.
#2 Abdominal Hernias: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/189563-overview
As much as 10% of the population develops some type of hernia during life. More than 1 million abdominal hernia repairs are performed each year, with inguinal hernia repairs constituting nearly 770,000 of these cases. Frequencies of various types of hernias are as follows: Approximately 75% of all hernias are inguinal; of these, 50% are indirect (male-to-female ratio, 7:1), with a right-side predominance, and 25% are direct; 3% of inguinal hernias have a sliding component, most often on the left side (left-to-right ratio, 4.5:1) […] About 14% of hernias are umbilical […] The prevalence of all varieties of hernias increases with age. Umbilical hernias occur in approximately one of every six children. They usually develop in infants and reach their maximal size by the first month of life. Most hernias of this type close spontaneously by the first year of life; the incidence in children older than 1 year is only 2-10%. Umbilical hernias are much more common in persons of African ethnicity. With respect to the pediatric population, umbilical hernias occur eight times more frequently in black infants than in white infants.
#2 Frequency of Abdominal Wall Hernias: A Nigerian Hospital Experience
https://www.ej-med.org/index.php/ejmed/article/view/1673
The order of frequency of the various hernias have undergone changes over the past few decades. […] However, a United Kingdom series covering three decades showed the following relative order of frequency: inguinal, umbilical, epigastric incisional, paraumbilical, femoral and other rarer hernia types like spigelian hernia. […] Our results revealed a somewhat similar sequence: inguinal, umbilical, incisional, epigastric, paraumbilical, femoral and others. […] Inguinal hernias accounted for 72.9% of all our hernia operations which is comparable to the 75% mentioned in several series, but still lower than the 86.3% mentioned in the same study from Cameroon. […] Our results show that 11.9% of these operations were done on emergent basis. […] In developed countries the proportion of emergent groin hernia repair ranges from 2.5% to 7.7%. […] While inguinal hernia still account for about three-quarters of all hernias, incisional hernia has become more prominent while femoral hernia is not as prevalent as has been taught in the past.
#2
https://journals.lww.com/international-journal-of-surgery/fulltext/2023/03000/the_global,_regional,_and_national_burden_and_its.18.aspx
The incident cases were highest among individuals aged 5069 years. […] The incident cases increased the most in the low SDI region, with the largest absolute increase occurring in Central Sub-Saharan Africa. […] In this study, the burden of inguinal, femoral, and abdominal hernias was greatest in Asia. Notably, South Asia, East Asia, and Southeast Asia accounted for approximately half of the worldwide incident cases. […] The ASIR exhibited a decreasing trend in South Asia, consistent with the trend worldwide. […] The need for hernia management has become an important socioeconomic problem and may affect healthcare systems worldwide, especially in China and India. […] Thus, more efforts are needed to increase access to safe hernia repair and to reduce the burden of inguinal, femoral, and abdominal hernias in limited-resource settings.
#2 Umbilical hernia: when and how – Maia – Annals of Laparoscopic and Endoscopic Surgery
https://ales.amegroups.org/article/view/5123/html
However, non-surgical group had a significantly higher utilization of healthcare and estimated days off work than the surgical group, concluding that early intervention decreases costs and resource utilization. […] The incidence of umbilical hernias in cirrhotic patients is approximately 20%, higher than in the general population and occurs more on males than in females. […] Umbilical hernia repair in a cirrhotic patient with ascites is a very challenging scenario. […] The most conventional approach to emergency umbilical hernia is the open hernia repair, especially if the patients are premorbidly unwell, be it with or without bowel resections. […] However, the laparoscopic approach is acceptable and may even be preferred when the patient is obese or when the presentation is early especially if there are no bowel resections required.
#2 Umbilical Hernia: Symptoms, What It Is, Treatment & Surgery
https://my.clevelandclinic.org/health/diseases/umbilical-hernia
Umbilical hernias are most common in newborns, babies and young children. But adults can get them, too. […] Umbilical hernias are three times more common in females than in males. […] In adults, umbilical hernias happen when pressure in your abdomen causes weaknesses in your abdominal wall muscles. […] Several factors can increase your risk, including: Sex. Females are more likely to have umbilical hernias. […] Umbilical hernias in adults are more likely to worsen and cause complications. […] It’s important for you and your provider to monitor your hernia and time treatment to prevent the hernia from progressing. […] Most adults eventually need surgery. […] Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low. […] In adults, they’re considered more high risk.
#2 Pediatric Umbilical Hernia | ACS
https://www.facs.org/for-patients/the-day-of-your-surgery/pediatric-umbilical-hernia/
Umbilical hernias are one of the most common conditions in children. They occur equally among boys and girls and in 15 to 23% of newborns. They are very common in African-American, Hispanic and low birth-weight infants. […] The risk of incarceration of umbilical hernia in children is rare (less than 1 in 100) but premature infants have 2x the risk. More than 2/3 of incarcerations occur before age 1 year. […] Watchful waiting is recommended for children who have no symptoms. In 95% of cases, umbilical hernias less than 1 cm in diameter close on their own within 5 years of age. After age 5, repair is recommended. […] Both incarceration and strangulation requiring emergency surgery occur in less than 1 in 100 children with umbilical hernias. Surgical outcome is good in children, even with incarcerated or strangulated hernias, as long as fluid and electrolyte balance is corrected and the hernia is repaired quickly.
#2 Umbilical Hernias in Adults: Epidemiology, Diagnosis and Treatment
https://ouci.dntb.gov.ua/en/works/4EgJDo09/
The literature on umbilical hernias in adults remains less extensive compared to other types of hernias. […] Adult umbilical hernias are frequently asymptomatic. […] The most frequent reasons for consultation are pain and esthetic discomfort. […] The diagnosis is most often evident on physical examination of the abdomen with tumefaction in the umbilicus. […] Despite the recent advances in terms of mesh varieties and minimally invasive surgery (laparoscopic and robotic surgery), there is still no real consensus on the optimal method for repair of umbilical hernia. […] Based on the patient characteristics and the context, âtailored and optimized surgeryâ should always be used to have the best results.
#2 Umbilical Hernia | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/umbilical-hernia
Umbilical hernias occur in approximately 20 percent of all newborns, but are more common in African-Americans and premature infants. […] Because the risk of incarceration (abdominal contents trapped in the sac) is rare, and many of these will close spontaneously on their own without requiring surgery, we generally observe children until they are 4 to 5 years of age before proceeding with surgical repair.
#3 Pediatric Umbilical Hernia | ACS
https://www.facs.org/for-patients/the-day-of-your-surgery/pediatric-umbilical-hernia/
Umbilical hernias are one of the most common conditions in children. They occur equally among boys and girls and in 15 to 23% of newborns. They are very common in African-American, Hispanic and low birth-weight infants. […] The risk of incarceration of umbilical hernia in children is rare (less than 1 in 100) but premature infants have 2x the risk. More than 2/3 of incarcerations occur before age 1 year. […] Watchful waiting is recommended for children who have no symptoms. In 95% of cases, umbilical hernias less than 1 cm in diameter close on their own within 5 years of age. After age 5, repair is recommended. […] Both incarceration and strangulation requiring emergency surgery occur in less than 1 in 100 children with umbilical hernias. Surgical outcome is good in children, even with incarcerated or strangulated hernias, as long as fluid and electrolyte balance is corrected and the hernia is repaired quickly.
#3 Umbilical Hernia: Symptoms, What It Is, Treatment & Surgery
https://my.clevelandclinic.org/health/diseases/umbilical-hernia
Umbilical hernias are most common in newborns, babies and young children. But adults can get them, too. […] Umbilical hernias are three times more common in females than in males. […] In adults, umbilical hernias happen when pressure in your abdomen causes weaknesses in your abdominal wall muscles. […] Several factors can increase your risk, including: Sex. Females are more likely to have umbilical hernias. […] Umbilical hernias in adults are more likely to worsen and cause complications. […] It’s important for you and your provider to monitor your hernia and time treatment to prevent the hernia from progressing. […] Most adults eventually need surgery. […] Surgery to treat umbilical hernias is also very effective, and the risk of the hernia coming back is low. […] In adults, they’re considered more high risk.
#3 Umbilical Hernias: Guide to Symptoms & Treatment | Columbia Surgery
https://columbiasurgery.org/conditions-and-treatments/umbilical-hernias-guide-symptoms-treatment
Up to 2% of the adult population has an umbilical hernia, and is more common in those who are overweight, had multiple pregnancies, or with liver cirrhosis. […] Even though some smaller hernias without symptoms can be watched over time, most research shows that even small hernias progress over time, therefore repairing them early may be beneficial. […] All laparoscopic/robotic repairs involve the use of mesh reinforcement, as this has been shown to reduce the risk of recurrence in larger hernias. […] Complications of umbilical hernia repair are rare, and include but are not limited to: Hernia recurrence (1-3%). […] Your doctor typically will want to see you back for a 2-3 week follow up appointment.