Inguinal hernia in neonates and ex-preterm: complications, timing and need for routine contralateral exploration

Abstract

The results of our series demonstrated that, though technically demanding, herniotomy in the neonate and ex-preterm is associated with a relatively low incidence of complications. Based on our results and in accordance with literature data, we do not advocate routine contralateral exploration in case of unilateral hernia but surgery to be performed only on the symptomatic side, as soon as possible after initial diagnosis. Very low birth weight patients should be followed with care in the early postoperative period due to the higher likelihood of developing a metachronous hernia.

Individualized Treatment of Inguinal Hernia in Children

“…On the other hand, many studies have demonstrated no significant difference in incarceration rates between patients undergoing hernia repair before (18.1%) and after (11.3%) discharge [37][38][39][40][41]. Of note, weight (either at birth or at incarceration), prematurity, sex, and side did not significantly correlate with the incidence of incarceration [42]. Many surgeons have also reported that early surgery for inguinal hernia in preterm infants increases five times the risk for postoperative apnea and ventilator dependence, with a maximum percentage of 4.7 in case of infants with postconceptional age less than 45 weeks [41,43].…”

“…More specifically, respiratory problems were reported in 5.1 and 3.3% of the patients with early and late repair, respectively [37][38][39][40]44]. Moreover, many surgeons have observed a 1-9% possibility of recurrence, if preterm babies were operated before discharge, due to the small anatomic area during surgery and the friable hernia sac [42,45,46]. Between preterm patients with early repair of inguinal hernia and those with late repair, the recurrence rate was 5.7% against 1.8% [37][38][39][40].…”

“…It has been reported that gender, age, and birth weight have no influence on the development of a contralateral metachronous hernia [47,48]. Many surgeons prefer to explore and repair the contralateral side, especially if the patient has birth weight less than 1500 gr, if it is a female, and if the operation is scheduled for a left-sided hernia [42]. It can be understood that during laparoscopic surgery, the inspection of the contralateral side is very easy to perform, but in case of open surgery, the exploration of the other side implies an increased risk of vas deferens and vessels' injury.…”

Implementing Contralateral Surgical Exploration during Hernia Repair in Children with Unilateral Inguinal Hernia: A Dutch Qualitative Study

“…In the past, it has already been repeatedly concluded that routine contralateral exploration in children is not indicated, though both pediatricians and surgeons that were interviewed feel that contralateral exploration might still be indicated in children with an increased risk of developing a MCIH (e.g., premature or low-weight infants and children with a ventriculoperitoneal shunt in situ). Based on the currently available literature, most authors do not advocate routine exploration, though no clear recommendations can yet be made, and contralateral exploration in premature or low-weight infants might still be considered [15,[25][26][27][28][29].…”

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

“…Inguinal hernia (IH), the most common disease requiring surgery in children, has an incidence of 3%–5% in term infants [ 1 ] which is increased by up to 30% in premature infants [ 2 ]. Although IH unequivocally requires surgical treatment, the timing of surgery remains controversial [ 3 4 ]. Some authors recommend surgery immediately following diagnosis to avoid significant complications caused by incarceration and testicular atrophy [ 5 6 ], and thus, IH repair (IHR) is performed before discharge from the neonatal intensive care unit (NICU).…”