Pediatric Surgery

Pediatric Surgery

Umbilical hernia

Hernias of the umbilicus (belly button or navel) are caused by the intestine pushing through a ring-like opening in the mid-abdominal wall. The umbilical opening is provided for the exit of blood vessels which connect baby to mother during growth in the uterus. After birth these blood vessels shrink faster than the surrounding ring in the infant's abdominal wall. A hernia forms when intestine or fat from inside the abdominal cavity pushes through the defect next to the shrunken vessels.

Most umbilical hernias will shrink and close spontaneously. Surgical repair is seldom performed in small infants and rarely recommended for children under three years of age. Spontaneous closure becomes unlikely after five years of age and surgical closure is then advised. When the opening is very large (1.5 to 2 cm) spontaneous closure is less likely and repair may be done in children younger than four years of age.

Bowel rarely becomes incarcerated (trapped) at the umbilicus. Even very large bulges will disappear when the child relaxes and the herniated bowel falls back inside the abdomen. Should the bowel become trapped, swollen, and tender, however, emergency evaluation is important to avoid bowel injury and possible perforation. Appropriate surgical repair will then be performed.

The office visit

When your child sees us, he or she will be seen by either the pediatric surgery nurse practitioner or the surgery resident. They will perform a history and physical examination on your child, answer any questions you may have and complete all necessary paperwork. They will then discuss their findings with the attending pediatric surgeon. Your child's pediatric surgeon will also examine your child and explain the procedure in detail.

Scheduling

If surgical repair is indicated, once the paperwork has been completed, you will be taken to meet the surgery scheduler. She will be your contact person. She will inform you of the surgery date as well as the date of their PATS (Pre-Admission Testing) appointment.

The operation

Your child's operation may be performed at the Outpatient Surgery Center (OSC) if your child meets the criteria; otherwise, it will be performed at the Loma Linda University Children's Hospital.

Your child's surgeon will answer any questions you may have after the procedure is completed.

The procedure involves a small incision in the skin fold below the umbilicus. Stitches are buried beneath the skin and do not require removal. Small paper tapes (Steristrips) usually cover the incision and should be left in place until your child returns for the post-operative visit. Immediatiely after the operation, a pressure dressing may be in place over the Steristrips. Your surgeon will instruct you when this outer dressing can be removed.

Postoperative care

Medications

Pain control rarely requires more than over-the-counter pain relievers such as Children's Tylenol or Children's Advil. These may be given every four hours as needed.

Any other medications your child required before the operation should be continued on the regular schedule afterward.

Diet

Nausea following general anesthesia is uncommon in infants. However, older children may experience nausea after discharge. Initially, liquids may be tolerated better than solids. There are no dietary restrictions once the nausea has passed and your child is alert and hungry.

Activity

Small children require no restriction of activity following umbilical hernia surgery. They may have enough initial discomfort to limit their activity voluntarily for a day or so. However, larger children should avoid body contact sports for at least two weeks.

Wound care

Always wash your hands before touching or cleaning the incision area. Some blood staining of the paper tapes on the incision is common. If the blood is dry and not spreading, the staining is not a problem. If the blood seems fresh, the amount is increasing, or if the paper tape is blood soaked and partially floating above the skin, apply gentle pressure with a clean washcloth for five to six minutes. Then, contact the pediatric surgery resident on call (909) 558-4000. The problem is usually minor but the surgeon needs to know about it.

Bathing

No tub baths should be given for at least two days after the operation. Sponge bathing for infants and showering for older children are permitted the day following the operation. Carefully pat dry the incision tapes after showering.

When to call your child's surgeon

  • Fever above 101oF that does not come down with Tylenol (mild fever is common)
  • Difficulty breathing, with or without a croupy cough
  • Active bleeding from the incision
  • Redness, swelling, or persistent pain in the incision

Follow-up

A clinic appointment needs to be scheduled one to two weeks after the operation. Please call (909) 558-4848 to schedule this appointment.

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