Thoracoabdominal and General Surgery

Anaesthesia for inguinal hernia repair in the newborn or ex-premature infant

“…The risks of anaesthesia in infancy must be balanced with the risk of incarceration, which is highest in the first 6 months of life, and surgical preference is usually to schedule surgery sooner rather than later. 1,3 An incarcerated hernia carries a risk of serious complications such as intestinal obstruction and strangulation of the hernial sac contents, and must be reduced. Manual reduction is usually attempted.…”

“…Some patients presenting with a unilateral hernia may be at risk of developing a second hernia on the contralateral side, and some surgeons will also explore the contralateral side during surgery. 1,3 Laparoscopic repair is an option for the management of inguinal hernia in infancy. Advantages of laparoscopic repair include better visualisation of the anatomy with better ability to explore the contralateral side and ligate if indicated.…”

“…Minimally invasive surgery is also associated with improved cosmesis, reduced length of stay, and improved postoperative pain scores. 3,4 Anaesthetic considerations for laparoscopic surgery in infants are outlined below.…”

“…Ten percent of hernias in term neonates are bilateral; this bilateral presentation is more common in premature and LBW infants, occurring in up to 50% of patients. 1,3 In addition to prematurity and low birth weight, inguinal hernia in infants may also be associated with other conditions: 1 (i) urological anomaliesdhypospadias, cryptorchidism, bladder extrophy; (ii) increased intra-abdominal pressuredpresence of ventriculo-peritoneal shunts, ascites, peritoneal dialysis; (iii) abdominal wall defectsdexomphalos and gastroschisis; (iv) family history of inguinal hernia; (v) other conditions (e.g. cystic fibrosis, mucopolysaccharidosis, EhlerseDanlos syndrome, and Marfan syndrome).…”