Management of Incarcerated Indirect Hernia in Pediatric Patients with Intra-abdominal Hypertension: A Retrospective Study

Abstract

Background: Intra-abdominal hypertension (IAH) is a critical condition that can be induced by incarcerated indirect inguinal hernia (IIIH). There are currently no specific guidelines for laparotomy in children. To determine whether laparotomy should be performed during the management in pediatric patients with IIIH combined with IAH.Methods: This is a retrospective study of pediatric patients with IIIH and IAH who were admitted and treated at the Department of General Surgery of Jiangxi Provincial Children’s Hospital from 01/2010 to 06/2020. The patients were divided into Group A (intra-abdominal pressure (IAP) of 10-20 mmHg) and Group B (IAP ≥ 21 mmHg). Each group was further subdivided into Group 1 (decompression) and Group 2 (no decompression) depending on whether decompressive laparotomy was performed or not. The last follow-up was three months after discharge.Results: A total of 49 patients were enrolled, and divided into group A1 (n = 21), A2 (n = 10), B1 (n = 4), B2 (n = 14). Compared with patients in group A1, those who had decompression (group A2) has longer hospital stay (7.5 ± 1.9 vs. 5.2 ± 2.1, p = 0.01), higher 24h-postoperative IAP (11.3 ± 2.4 vs 9.5 ± 2.1, p = 0.03), longer PICU stay (2.1 ± 0.9 vs. 1.1 ± 0.5, p = 0.001), and more perioperative complications. In contrast, among patients with IAP higher than 20mmHg, those who had decompresion via laparotomy (group B2) had comparable hospital stay (7.1 ± 5.1 vs. 8.5 ± 4.1, p = 0.57), a shorter PICU stay (3.0 ± 1.4 vs. 4.7 ± 1.3, p = 0.04) and lower mortality rate (7.1% vs. 50%, p = 0.04) than patients in group B1.Conclusions: The selection of appropriate surgical methods according to IAP and based on clinical diagnosis can relieve the pain of children, shorten hospital stay, and reduce the mortality rate.