Wisconsin surgeons are performing more umbilical hernia repairs on patients two years old or younger, and more umbilical hernia repairs per capita, compared to surgeons in two other states, according to researchers at the University of Wisconsin School of Medicine and Public Health.

Umbilical hernias (bulging tissues near the belly button) are present in about 20 percent of newborns but up to 90 percent close spontaneously by age 4, without the need for an operation. Surgery at younger ages may put children at risk of an unnecessary operation for a condition that can resolve on its own and almost never causes complications.

Jonathan Kohler
Jonathan E. Kohler

The study team looked at 6551 cases from three states -- Wisconsin, New York and Florida -- from 2012 through 2014. Wisconsin had the highest percentage (13.8 percent) of surgeries on children two years and younger compared to the two other states. That percentage was significantly higher than Florida (8.3 percent) and New York (5.4 percent). Perhaps because Wisconsin children undergo repairs of hernias that would otherwise close on their own, the rate of umbilical hernia repairs in Wisconsin was about 50 percent higher (0.94 repairs per 1000 children) than in New York (0.61) and Florida (0.68).

“Our findings demonstrate that in Wisconsin, unlike other states for which we have good data, elective umbilical hernia repairs are routinely performed in very young children,” said Jonathan Emerson Kohler, MD, FACS, assistant professor of surgery. “At American Family Children’s Hospital, our guideline is four years old and older since umbilical hernias often close on their own.”

In addition, the study found:

  • White children are more likely to have an early repair than other racial or ethnic groups.
  • Pediatric patients living in rural areas and those with Medicaid were also more likely to have early repairs.
  • But state of residence was the most predictive of having a hernia repaired at a young age, even taking those other factors into consideration.

Kohler said the likelihood of early hernia repair is similar at community hospitals and for pediatric specialists at children’s hospitals.

“For most children, umbilical hernias often close on their own and can be monitored safely through watchful waiting, said Kohler. “Evidence-based clinical practice guidelines are needed to help standardize indications for the appropriate timing of hernia repairs. Such guidelines could encourage surgeons, primary care doctors, and parents to avoid unnecessary operations and operative and anesthetic risks.”

The study is reported in The Journal of Pediatrics.