A Review of the Incidence, Manifestation, Predisposing Factors, and Management of Recurrent Pediatric Inguinal Hernia

Abstract

Recurrent pediatric inguinal hernia is relatively rare. In a large series, the recurrence rates vary from 0.3 to 1.2%. In a university hospital with surgical service for a wide spectrum of sick pediatric patients, the real recurrence rate may be 3 to 6%. Recurrence manifests typically 6 months after first repair. Current evidence indicates that recurrence rates in open and laparoscopic repair are similar. Laparoscopic repairs are, however, still performed by a minority of skilled pediatric surgeons, whereas the majority of pediatric surgeons rely on open repair not least because of the assumed lower risk of recurrence. After repair of an indirect hernia, the majority of recurrences (97%) are indirect, whereas in rare cases the recurrence turns out to be a formerly undiagnosed direct or femoral hernia. In Children's Hospital of Helsinki, Finland, recurrence rate from 2012 to 2016 was 2.8% and operations for recurrent hernias comprised 3.3% of the total. From 1991 to 2017, a total of 130 operations for recurrent hernias were performed with open inguinal approach (n = 75, 58%), laparoscopy (n = 49, 38%), and laparotomy (n = 4, 4%). One teenage patient underwent a Lichtenstein Prolene net repair. A recurrent inguinal hernia can be repaired either with an open or laparoscopic approach. In laparoscopy, the nature of the recurrent hernia can be clarified and an immediate repair performed either by laparoscopic or open technique. In expert hands new laparoscopic techniques using muscular arch, lateral umbilical ligament, iliopubic tract, and division of the sac may be an alternative to a simple purse-string closure.

Laparoscopic percutaneous extraperitoneal closure with peritoneum reinforcement repair for pediatric inguinal hernia: a single-center experience with over 2,000 patients

“…The last case, another infant had increased abdominal pressure for a long time after surgery. We found that one of the common features of these patients with recurrence was that they all had increased abdominal pressure and/or violent pull as risk factors shortly after surgery (13,19). These recurrent patients were followed up for another 3 years after reoperation.…”

Modification of the Classical Percutaneous Extraperitoneal Procedure for Pediatric Inguinal Hernia to Reduce Complications: A Multiple-Centered Comparison Study

“…The recently reported recurrence rate of laparoscopic inguinal hernia repair in children is 0.3-1.2% 15 .…”

Multifactor study of efficacy and recurrence in laparoscopic surgery for inguinal hernia

“…In recent years, laparoscopy has been widely used in clinical practice with small incisions, slight trauma, few complications, etc ., but studies have shown that there is still a certain recurrence rate after laparoscopic surgery. Therefore, the high-risk factors that cause recurrence after laparoscopic surgery for inguinal hernia have been analyzed, and early prevention and treatment to improve the prognosis of children has been deemed significantly important[ 4 ].…”