A 36 month old female presents for elective surgical repair of a small umbilical hernia. Which of the following is the MOST IMPORTANT element of your preoperative assessment in determining whether to proceed with the case?
a) Age of the patient
b) Family history of umbilical hernia
c) History of intestinal incarceration
d) Size of the hernia defect
Answer c. In most patients umbilical hernias resolve spontaneously by age two years. In the remainder, the usual course of treatment is delayed closure after age 5 years in order to minimize the risk of anesthetic complications. Smaller lesions are more likely to close spontaneously, but also more likely to result in bowel incarceration and strangulation. Elective repair of umbilical hernias is warranted for patients under age five who demonstrate symptoms of incarceration in order to decrease the risk of bowel injury.