Minimally invasive closure of pediatric umbilical hernias.
BACKGROUND
Pediatric umbilical hernias may close spontaneously by concentric fibrosis and scar tissue formation. Some hernias do not close. This study was developed to assess this novel minimally invasive closure (MIC), using injectable material to close the umbilical defect.


METHODS
Twenty-five children with umbilical hernias of 1.5 cm or less were included in the study. Deflux (Q Med, Uppsala, Sweden), a biodegradable compound of dextranomer microspheres in hyaluronic acid, was injected percutaneously in the border and preperitoneal space in 4 quadrants of the hernia defect, thereby occluding the lumen. Follow-up visits were obtained at approximately 1 week, 3 months, and 1 year.


RESULTS
Two to twenty-four months after surgery, 21 of the 25 umbilical hernias were closed (84%). To date, there have been no complications from the injected compound substance. The average age at the time of the MIC was 6 years and 7 months, ranging from 4 months to 17 years. The average defect was more than 6.4 mm, ranging from 4 to 14 mm.


CONCLUSIONS
Minimally invasive closure procedure with injection of dextranomer hyaluronic acid copolymer can safely be used to close umbilical hernias. The procedure closed or reduced the size of hernias in our patients immediately after surgery; and within months, 21 (84%) of 25 were closed. One defect has not closed in 1 year and will need repair. The remaining 3 defects are small and may go on to close by ongoing fibroblast ingrowth and collagen deposit. The MIC procedure may be an alternative to open repair of umbilical hernias. Increased experience and long-term follow-up will determine the true efficacy of this new technique.
Feins
Neil R
NR
Department of Pediatric Surgery, Children's Hospital Boston, Boston, MA 02115, USA. neil.feins@childrens.harvard.edu
Dzakovic
Alexander
A
Papadakis
Konstantinos
K
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003911:Dextrans / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006554:Hernia, Umbilical / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D018570:Risk Assessment; D013718:Tensile Strength; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D003911:Dextrans; C013471:dextranomer; D006820:Hyaluronic Acid