Clinical presentation and surgical treatment outcomes in children with umbilical hernia at Moi Teaching and Referral Hospital- Eldoret Kenya

Abstract

Background: Umbilical hernia is common among Afro-Caribbean children with a prevalence of between 15-23%. Although largely harmless, it can cause serious complications like strangulation and evisceration. The majority of the surgical repairs are done as an emergency rather than electives due to strong cultural influence, which delays early surgical intervention. There is a paucity of data on the treatment outcomes following surgical repair. Objective: To describe the clinical presentations and surgical treatment outcomes in children with umbilical hernia at Moi Teaching and Referral Hospital. Methods: This was a descriptive prospective study conducted between March 2019 to March 2020. A total of 39 participants aged below 18 years were recruited. Data on socio-demographics, clinical evaluation, indication for surgery and post-operative outcomes were collected using an interviewer-based questionnaire. Descriptive statistics including frequencies and proportions were used for categorical variables while measures of central tendency and spread were used for continuous variables. Treatment outcomes were assessed in terms of complications, mortality and length of hospital stay at 24 hours and day 14 post-operatively. Students' T-test and Analysis of Variance were used to assess the association between categorical variables at 0.05 α level of significance. Results: Patients' age ranged between 5 to 147 months with a median of 25 (IQR: 14,50) months. Females constituted 51.3% (n=20). Majority of participants (92.3%) had normal nutritional status. Few participants (18%) had a positive family history of umbilical or inguinal hernia. Umbilical swelling with pain (n=32) was the commonest symptom while irreducible tender swelling (n=29) was the main clinical finding. A greater proportion (64.1%) had a moderate-sized defect. Incarcerated umbilical hernia was the commonest pre-operative diagnosis (66.7%). Seventy-four per cent (n=29) underwent emergency hernia repair, with incarceration accounting for 89.7%. One participant developed a hematoma post-operatively. The mean length of hospital stay was 2.40 (std=0.89) days. Overall mortality rate was 2.6%. Defect size had a statistically significant influence on the length of hospital stay (p-value=0.002). Conclusion: Median age for UH repair at MTRH is 25 months. Most of the UH repairs are done as an emergency, with incarceration being the leading cause of complicated UH. Operative repair remains a low-risk procedure. The size of the defect is a predictor of the length of hospital stay. Recommendation: Since most of the children in our set-up present at a young age with complicated UH, early surgical intervention should be considered.