Recurrent Inguinal Hernias

Shelley, Harold J.

doi:10.1001/archsurg.1940.01210060134012

Cited by 6 publications

(1 citation statement)

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“…The recommendations for the care of epigastric hernias in children are primarily derived from adult literature and may not fully address the unique characteristics of these hernias in pediatric patients [26][27][28][29][30]. Unlike in adults, epigastric hernias in children are typically asymptomatic in the majority of cases (63%), reducible (65%), and may involve multiple fascial defects (13%) [3].…”

Section: Epigastric Herniasmentioning

confidence: 99%

The evidence mismatch in pediatric surgical practice

Broomfield,

Agabani,

Guadagno

et al. 2023

Pediatr Surg Int

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PurposeOutpatient pediatric surgical practice often involves conditions of limited morbidity but signi cant parental concern. We explore existing evidence-based management recommendations and the mismatch with practice patterns for four common outpatient pediatric surgical conditions. MethodsUsing the Cochrane Rapid Review Group recommendations and librarian oversight, we conducted a rapid review of 4 outpatient surgical conditions: dermoid cysts, epigastric hernias, hydroceles, and umbilical hernias. We extracted patient demographics, intervention details, outcome measures and evaluated justi cations presented for chosen management options. A metric of evidence volume (patient/publication ratio) was generated and compared between diagnoses. ResultsOut of 831 articles published since 1990, we identi ed 49 cohort studies (10-dermoid cyst, 6-epigastric hernia, 25-hydrocele, and 8-umbilical hernia). The 49 publications included 34,172 patients treated across 18 countries. The evidence volume for each out-patient condition demonstrates <1 cohort/condition/year. The evidence mismatch rate varied between 33-75%; many existing recommendations are not evidence-based, sometimes con icting and frequently misrepresentative of clinical practice. ConclusionsPublished literature concerning common outpatient pediatric surgical conditions is sparse and demonstrates wide variations in practice. All individual practice choices were justi ed using either risk of complications or patient preference. Most early intervention practices were based on weak or outdated studies and "common wisdom" rather than genuine evidence.

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Section: Epigastric Herniasmentioning

confidence: 99%