Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
For umbilical hernias, repair is generally delayed until the patient is at least four years of age, though some recommendations suggest two years as the lower age limit. — Meera Kotagal, Umbilical Pathology: Diagnosis and Management in Pediatric Surgery · 3:57
Umbilical Pathologies Bonus Episode
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This is a "snack size" bonus episode of 'Peds Umbilical Pathologies in Brief: Presentation, Workup, Diagnosis, Perioperative Considerations' video.For full video: https://www.youtube.com/watch?v=lmzIp8hXAG8 -Original Video Description- Umbi
podcast4:25 · Apr 2022
Differential diagnosis and management of pediatric umbilical pathologies
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Umbilical pathologies can present with a wide range of symptoms so here, we cover the basics of presentation, differentiation, diagnosis, surgical approach, and
podcast6:19 · Nov 2026
Diagnosis and Management of Pediatric Umbilical Pathologies
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Dr. Meera Kotagal, Dr. Rae Hanke, and Dr. Gillian Goddard come together to provide you the essential on diagnosis and management of pediatric umbilical hernias.
podcast6:44 · Nov 2026
Umbilical Pathology: Diagnosis and Management in Pediatric Surgery
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Dr. Meera Kotagal, Dr. Rae Hanke, and Dr. Gillian Goddard come together to provide you the essential on diagnosis and management of pediatric umbilical hernias.
Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang,
video6:48 · Nov 2026
Patients go to the OR for pyloromyotomy once their bicarb level is less than 30, their chloride is greater than 100, and their potassium is normal. — Meera Kotagal, Pyloric Stenosis Guideline Recap · 3:00
Pyloric Stenosis Guideline Recap
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Dr. Meera Kotagal discusses the preoperative and post-operative management of pyloric stenosis. These guidelines are currently followed at Cincinnati Children's Hospital (January 2019) as guided by the following studies:Dalton BGA, et al. O
video · Aug 2022
If a patient has an undescended testicle that's palpable in the inguinal canal, you should plan to do an orchiopexy at the time of your inguinal hernia repair. — Meera Kotagal, Pediatric inguinal hernia diagnosis, management, and complications · 14:01
Pediatric inguinal hernia diagnosis, management, and complications
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Inguinal hernia repair is the second most common surgery performed by pediatric surgeons. Here, we discuss the basics of diagnosis and management for inguinal h
podcast15:59 · Nov 2026
Iatrogenic arteriovenous fistula in the Arm in an infant: Diagnostic and therapeutic considerations
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Abstract Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3‐month‐old infant with complicated gastroschisis requiring multi
article · Nov 2026
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Umbilical Pathologies Bonus Episode
Umbilical hernia is the most common cause of umbilical bulge in infants.
clinicalMeera Kotagal0:34 ↗
The differential diagnosis of umbilical bulge includes umbilical hernia, urachal cyst, patent omphalomesenteric duct, umbilical granuloma, umbilical polyp, and omphalitis (when significant erythema is present).
clinicalMeera Kotagal0:34 ↗
Urine draining from the umbilicus is associated with a patent urachus.
clinicalMeera Kotagal1:00 ↗
Succus draining from the umbilicus suggests a patent omphalomesenteric duct.
clinicalMeera Kotagal1:00 ↗
When ultrasound shows patent urachus or patent omphalomesenteric duct, the next step is usually operative exploration.
Host summaryEllen Encisco summarizes what Dr. Mira Kotigal said — not the host's own clinical position1:25 ↗
An umbilical polyp is a small remnant of the omphalomesenteric duct extending from the umbilicus that can be excised.
clinicalMeera Kotagal1:56 ↗
An umbilical granuloma is granulation tissue or asymptomatic pink tissue at the base of the umbilicus, often seen in very small infants shortly after umbilical cord separation, treated with silver nitrate.
clinicalMeera Kotagal1:56 ↗
On physical exam, an umbilical polyp has a stalk and can be moved around more freely, whereas granulomatous tissue is more stuck on at the base of the belly button.
Host summaryEllen Encisco summarizes what Dr. Mira Kotigal said — not the host's own clinical position2:16 ↗
The primary risk factor for umbilical hernias is prematurity.
epidemiologicalMeera Kotagal2:42 ↗
African-American infants are 8 times more likely to have an umbilical hernia compared to Caucasians.
epidemiologicalMeera Kotagal2:42 ↗
For umbilical hernias, clinicians generally wait until the patient is at least 4 years of age before surgical repair.
Host summaryRod Gerardo summarizes what Dr. Mira Kotigal said — not the host's own clinical position2:56 ↗
85% of infant umbilical hernias will close on their own.
epidemiologicalMeera Kotagal3:09 ↗
Small umbilical hernia defects are more likely to close spontaneously compared to larger defects (those over 1 to 1.5 centimeters).
clinicalMeera Kotagal3:09 ↗
Routine pediatric umbilical hernias are repaired as an outpatient procedure.
clinicalMeera Kotagal3:28 ↗
Pediatric umbilical hernia repair does not use mesh, unlike adult repairs.
clinicalMeera Kotagal3:28 ↗
During pediatric umbilical hernia repair, it is important to close normal fascia to normal fascia, not hernia sac to hernia sac.
clinicalMeera Kotagal3:28 ↗
Pyloric Stenosis Guideline Recap
Pyloric stenosis presents with progressive nonbilious emesis and sometimes a palpable olive in the epigastrium.
clinicalMeera Kotagal0:00 ↗
Labs in pyloric stenosis most often demonstrate a hypochloremic, hypokalemic metabolic alkalosis.
clinicalMeera Kotagal0:00 ↗
Ultrasound criteria for pyloric stenosis are muscle width greater than 3 millimeters and length greater than 14 millimeters.
clinicalMeera Kotagal0:00 ↗
The Dalton et al. framework from Kansas City predicts the number of fluid boluses needed based on the original chloride level, so labs do not need to be rechecked between each bolus in children likely to require two or three saline boluses.
Host summaryMeera Kotagal summarizing a resource — not the host's own clinical position1:00 ↗
Maintenance IV fluid is started at one and a half times the maintenance rate in pyloric stenosis patients.
guidelineMeera Kotagal2:00 ↗
Potassium is added to IV fluids once urine output has been confirmed.
guidelineMeera Kotagal2:00 ↗
There is a trend in the literature that isotonic fluids should be used instead of hypotonic fluids in pediatric patients, though evidence is still developing in this age population.
opinionMeera Kotagal2:30 ↗
Patients go to the OR for pyloromyotomy once their bicarb level is less than 30, their chloride is greater than 100, and their potassium is normal.
guidelineMeera Kotagal3:00 ↗
Postoperative management includes a short NPO period of around two hours followed by ad lib feeding with breast milk or formula.
guidelineMeera Kotagal3:30 ↗
Randomized controlled trials by Markel et al. and Adebe et al. found that ad lib feeding compared to protocolized feeding is associated with equivalent or shorter hospital stays.
Host summaryMeera Kotagal summarizing a resource — not the host's own clinical position3:30 ↗
Ad lib feeding may result in more emesis but there were no complications associated with that emesis in the Markel and Adebe trials.
Host summaryMeera Kotagal summarizing a resource — not the host's own clinical position3:30 ↗
Differential diagnosis and management of pediatric umbilical pathologies
The differential diagnosis for a pediatric umbilical bulge includes umbilical hernia (most common), urachal cyst, patent omphalomesenteric duct, umbilical granuloma, umbilical polyp, and omphalitis if significant erythema is present.
clinicalMeera Kotagal0:49 ↗
Urine draining from the umbilicus is associated with a patent urachus.
clinicalMeera Kotagal1:17 ↗
Succus draining from the umbilicus suggests a patent omphalomesenteric duct.
clinicalMeera Kotagal1:22 ↗
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