WP1.5 - Outcomes of inguinal hernia repair in adolescents by both paediatric and adult surgeons- a retrospective observational study

Abstract

Abstract Aims Adolescent inguinal herniae are repaired by both paediatric and adult surgeons, but there is significant variation in operative technique. We aim to report both adult and paediatric practice, and to compare outcomes amongst different repair techniques. Methods Data were collected from records of patients aged 12-18 who underwent inguinal hernia repair in adult or paediatric services within our region between 2000 and 2023. Results 116 inguinal herniae in 106 adolescents were identified. 66% were repaired by paediatric surgeons. 85% were male. Median age was 14.1 years. Median length of follow-up was 15.0 years. 71% herniae were right-sided and 9% bilateral. 98% were indirect. 3% were incarcerated. 72% underwent open repair. Herniotomy with high ligation of the sac was the most common open operation in adult and paediatric practice. 28% herniae were repaired laparoscopically (64% by adult surgeons). Adult surgeons most commonly utilised total extraperitoneal repair, and paediatric surgeons most utilised closure of the deep ring. 4% recurred (all operated on by paediatric surgeons). 4% of patients developed chronic pain (80% from adult services). Only 1 of 5 patients with chronic pain had mesh repair. Logistic regression showed no independent variables predictive for recurrence or chronic pain. Conclusions There is significant variation in practice between adult and paediatric surgeons in adolescents with inguinal herniae. Recurrence was more common after repair by paediatric surgeons whilst post-operative chronic pain was less common. Paediatric and adult surgeons could learn from each other to optimise outcomes. This study also raises the question of who should be doing these procedures.