Optimal Timing for Repair of an Inguinal Hernia in Premature Infants

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2010 Feb 20

PMID 20169441

Citations 12

Authors

George Vaos

Stefanos Gardikis

Katerina Kambouri

Ioannis Sigalas

George Kourakis

George Petoussis

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to determine the optimal timing for inguinal herniotomy in premature infants treated in the neonatal intensive care unit.

Methods: A two-institutional-center retrospective study was performed including 41 prematures at gestational age 28-35 weeks who underwent herniotomy within 1 week of diagnosis [short-waiting group (SWG), median 5 days, n = 25] or more than 1 week after diagnosis [long-waiting group (LWG), median 30.55 days, n = 16]. Gestational age, birthweight, post-conceptional age at diagnosis, age at diagnosis, post-conceptional age at surgery, age at surgery, weight at surgery, timing of surgery, operative time, and occurrence of incarceration, postoperative apnea, hernia recurrence, testicular atrophy, and hospital stay were compared between the two groups. Statistical analysis was performed using one-way ANOVA.

Results: Twelve preoperative episodes of incarceration occurred: three in the SWG and nine in the LWG (P < 0.05). Six infants had apnea postoperatively: four in the SWG and two in the LWG (P > 0.05). Follow-up revealed five hernia recurrences, one in the SWG and four in the LWG (P < 0.05); four testicular atrophies were found, one in the SWG and three in the LWG (P > 0.05).

Conclusion: Early elective herniotomy should be considered in prematures in order to avoid perioperative morbidity and to reduce the risk of incarceration and subsequent testicular ischemia, and hernia recurrence.

Citing Articles

Neighborhood child opportunity and its association with complicated inguinal hernia in children: an analysis of a national insurance claims-based database.

Dickerson T, Bodek B, Diaz L, Agala C, Phillips M, E McLean S Pediatr Surg Int. 2025; 41(1):91.

PMID: 40044997 DOI: 10.1007/s00383-025-05989-w.

Can we preserve the necrotic testis caused by incarcerated inguinal hernia in infants under 3 months?.

Hou J, Feng W, Liu Q, Wang Y, Guo Z, Liu W Pediatr Surg Int. 2023; 40(1):16.

PMID: 38042759 DOI: 10.1007/s00383-023-05592-x.

Optimal timing for inguinal hernia repair in premature infants: surgical issues for inguinal hernia in premature infants.

Cho Y, Kwon H, Ha S, Kim S, Kim D, Namgoong J Ann Surg Treat Res. 2023; 104(5):296-301.

PMID: 37179700 PMC: 10172032. DOI: 10.4174/astr.2023.104.5.296.

Costs and recurrence of inguinal hernia repair in premature infants during neonatal admission.

Peace A, Duchesneau E, Agala C, Phillips M, E McLean S, Hayes A J Pediatr Surg. 2022; 58(3):445-452.

PMID: 36529566 PMC: 10243490. DOI: 10.1016/j.jpedsurg.2022.10.006.

Risk of incarceration in children with inguinal hernia: a systematic review.

Olesen C, Mortensen L, Oberg S, Rosenberg J Hernia. 2019; 23(2):245-254.

PMID: 30637615 DOI: 10.1007/s10029-019-01877-0.

References

Harper R, Garcia A, Sia C . Inguinal hernia: a common problem of premature infants weighing 1,000 grams or less at birth. Pediatrics. 1975; 56(1):112-5. View

Steinau G, Treutner K, Feeken G, Schumpelick V . Recurrent inguinal hernias in infants and children. World J Surg. 1995; 19(2):303-6. DOI: 10.1007/BF00308645. View

Murdoch R . Testicular strangulation from incarcerated inguinal hernia in infants. J R Coll Surg Edinb. 1979; 24(2):97-101. View

Miserez M . Inguinal hernia repair in a premature infant. J Pediatr Surg. 2004; 39(2):252. DOI: 10.1016/j.jpedsurg.2003.10.031. View

William J, Stoddart P, Williams S, Wolf A . Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia. Br J Anaesth. 2001; 86(3):366-71. DOI: 10.1093/bja/86.3.366. View

Coren M, Madden N, Haddad M, Lissauer T . Incarcerated inguinal hernia in premature babies--a report of two cases. Acta Paediatr. 2001; 90(4):453-4. View

Kim J, Thornton J, Eipe N . Spinal anesthesia for the premature infant: is this really the answer to avoiding postoperative apnea?. Paediatr Anaesth. 2008; 19(1):56-8. DOI: 10.1111/j.1460-9592.2008.02831.x. View

Emberton M, Patel L, Zideman D, Karim F, Singh M . Early repair of inguinal hernia in preterm infants with oxygen-dependent bronchopulmonary dysplasia. Acta Paediatr. 1996; 85(1):96-9. DOI: 10.1111/j.1651-2227.1996.tb13898.x. View

Mayhew J, Bourke D, Guinee W . Evaluation of the premature infant at risk for postoperative complications. Can J Anaesth. 1987; 34(6):627-31. DOI: 10.1007/BF03010525. View

10.

Wiener E, TOULOUKIAN R, Rodgers B, Grosfeld J, SMITH E, ZIEGLER M . Hernia survey of the Section on Surgery of the American Academy of Pediatrics. J Pediatr Surg. 1996; 31(8):1166-9. DOI: 10.1016/s0022-3468(96)90110-4. View

11.

Uemura S, WOODWARD A, Amerena R, Drew J . Early repair of inguinal hernia in premature babies. Pediatr Surg Int. 1999; 15(1):36-9. DOI: 10.1007/s003830050507. View

12.

Cote C, Zaslavsky A, Downes J, Kurth C, Welborn L, WARNER L . Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology. 1995; 82(4):809-22. DOI: 10.1097/00000542-199504000-00002. View

13.

Misra D . Inguinal hernias in premature babies: wait or operate?. Acta Paediatr. 2001; 90(4):370-1. View

14.

GROFF D, Nagaraj H, Pietsch J . Inguinal hernias in premature infants operated on before discharge from the neonatal intensive care unit. Arch Surg. 1985; 120(8):962-3. DOI: 10.1001/archsurg.1985.01390320082017. View

15.

Murphy J, Swanson T, Ansermino M, Milner R . The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit?. J Pediatr Surg. 2008; 43(5):865-8. DOI: 10.1016/j.jpedsurg.2007.12.028. View

16.

FAHLSTROEM G, Holmberg L, Johansson H . ATROPHY OF THE TESTIS FOLLOWING OPERATIONS UPON THE INGUINAL REGION IN INFANTS AND CHILDREN. Acta Chir Scand. 1963; 126:221-32. View

17.

Antonoff M, Kreykes N, Saltzman D, Acton R . American Academy of Pediatrics Section on Surgery hernia survey revisited. J Pediatr Surg. 2005; 40(6):1009-14. DOI: 10.1016/j.jpedsurg.2005.03.018. View

18.

Rescorla F, Grosfeld J . Inguinal hernia repair in the perinatal period and early infancy: clinical considerations. J Pediatr Surg. 1984; 19(6):832-7. DOI: 10.1016/s0022-3468(84)80379-6. View

19.

Vogels H, Bruijnen C, Beasley S . Predictors of recurrence after inguinal herniotomy in boys. Pediatr Surg Int. 2009; 25(3):235-8. DOI: 10.1007/s00383-008-2309-3. View

20.

Weber Guimaraes Barreto M, Melo-Filho A, Neto J, Zeller C, Marba S, Sbragia L . Nutritional state and herniorrhaphy in premature infants. Pediatr Surg Int. 2004; 20(9):699-703. DOI: 10.1007/s00383-004-1278-4. View