Uncommon Hernias

Epigastric hernias in children and the use of ultrasound in its diagnosis

“…We have been able to establish this association using correlation analyses and indeed found that small fascial defects are much less likely to be found during clinical examination. The palpable fascial defect is not a prerequisite to make the diagnosis: the diagnosis is mainly established by the presence of a (para)median swelling in physical examination 3 27. The aspect of the palpable fascial defect is relevant because the swelling will often disappear in the operating room, but this can be addressed by preoperative marking of the localization of the swelling before induction of anesthesia 2 3.…”

“…In addition to these aspects, it must be taken into account that epigastric hernias might have a relevant risk of non-elective repair, which would be accompanied by an increased anesthetic risk. As the literature and subsequently the opinions of pediatric surgical departments assessed by Tinawi and Stringer3 are divided on the point of whether asymptomatic epigastric hernias should be repaired, some recommend it,2 4 7 33 while others prefer watchful waiting,13 27 we counsel the parents on both treatment options, but usually, in our experience, the parents will opt for the operative repair.…”