Inguinal Hernias In Premature Infants Research Articles

European Pediatric Surgeons' Association Survey on Timing of Inguinal Hernia Repair in Premature Infants.

This article evaluates the practice patterns of European Pediatric Surgeons' Association (EUPSA) members regarding the timing of inguinal hernia (IH) repair in premature infants. Online survey containing 29 questions distributed to EUPSA members during January 2023. A total of 180 responds were received. Overall, IH repair prior to discharge was favored by 60% of respondents when there was a history of incarceration and 56% when there was not. In the case of very/extremely premature infants (< 32 weeks) with no history of incarceration, fewer (43%) respondents postpone the surgery until after discharge. The majority of respondents cited the risk of incarceration as the reason for advocating surgery prior to discharge, whereas a reduced risk of apnea was the most cited reason for respondents who prefer delayed surgery. Open approach under general anesthesia was favored by 54% of respondents, with 27% of them preferring open approach with spinal anesthesia. Laparoscopic surgery for premature infants is used in 11% while 7% of them preferred in all premature infants including extremely/very premature ones. Contralateral side evaluation was never done by 40% of respondents and 29% only performed it only during laparoscopic repair. The majority of respondents (77%) indicated that they have an overnight stay policy for premature infants < 45 weeks of gestation. There is variation in the practice patterns of pediatric surgeons in the treatment of IH in premature infants. Due to the concern for the high risk of incarceration, IH repair before discharge was the most prevalent practice. Lower risk of postoperative apnea was cited as the most common reason for delaying surgery. Randomized studies are required to establish the optimal timing for IH repair in premature infants.

Inguinal Hernia in Premature Infants: To Operate Before or After Discharge from Hospital?

IntroductionThis study aims to find out the optimal timing for herniotomy for premature infants with inguinal hernia (IH): early during hospitalisation or delayed after hospital discharge. MethodA retrospective cohort study was conducted on premature infants diagnosed with IH during their initial hospitalization between 2015 and 2020. Demographic data and clinical outcomes were compared between infants undergoing herniotomy before discharge (“early”) and those who were discharged without herniotomy (“delayed”). Student's t-test or Mann–Whitney U test and Fisher's exact test were used for statistical analysis. ResultsOf 219 premature infants, 189 (86.3%) underwent early herniotomy, while 30 were discharged with unoperated IH. In the delayed group, 15 (50%) underwent planned delayed herniotomy, and the remaining 15 experienced spontaneous resolution (absence of inguinal bulge over at least 1-year follow-up). The gestational age and birth weight of both groups were similar. At surgery, the delayed group median (interquartile range) was significantly older (42.1[38–49] vs 37.7 [36–40] weeks, p < 0.001) and heavier (3.27 [2.21–4.60] vs 2.22 [2.00–2.70] kg, p < 0.001). Two infants (1%) in the early group presented with incarcerated IH requiring urgent operation. In the delayed group, no infant developed incarcerated IH while awaiting elective operation (time from diagnosis to operation 44 [21–85] days). There was no statistically significant difference in respiratory and surgical complications between the two groups, although the delayed group had lesser surgical complications (0% vs 9.5%). ConclusionDeferring herniotomy after discharge for premature infants is safe with close monitoring and associated with a chance of spontaneous resolution. Level of EvidenceLevel III, treatment study.

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

We analyzed the timing of inguinal hernia repair in premature infants in the neonatal intensive care unit (NICU) considering recurrence, incarceration, and other complications. In this multicenter retrospective review, premature infants (<37 weeks) in the NICU diagnosed with inguinal hernia between 2017 and 2021 were segregated into 2 groups based on the timing of inguinal hernia repair. Of 149 patients, 109 (73.2%) underwent inguinal hernia repair in the NICU and 40 (26.8%) after discharge. Preoperative incarceration did not differ, but complications with recurrence and postoperative respiratory insufficiency were higher in the NICU group (11.0% vs. 0%, P = 0.029; 22.0% vs. 5.0%, P = 0.01). Multivariate analysis showed that the significant factors affecting recurrence were preoperative ventilator dependence and body weight of <3,000 g at the time of surgery (odds ratio [OR], 16.89; 95% confidence interval [CI], 3.45-82.69; P < 0.01 and OR, 9.97; 95% CI, 1.03-95.92; P = 0.04). Our results suggest that when premature infants are diagnosed with inguinal hernia in the NICU, inguinal hernia repair after discharge may decrease the odds of recurrence and postoperative respiratory insufficiency. In patients who have difficulty delaying surgery, it is thought that surgery should be performed carefully in a ventilator preoperatively or weighed <3,000 g at the time of surgery.

Clinical regression of inguinal hernias in premature infants without surgical repair.

The incidence of inguinal hernias in premature infants is approximately 30%. Due to concerns about a high risk of incarceration, early repair is commonly performed. We present a series of patients whose families opted to delay repair until after 55weeks corrected gestational age (GA) and experienced safe clinical regression of their hernias. Between June 2015 and July 2020, premature infants (< 37weeks GA) diagnosed with inguinal hernias on physical examination were identified. Families of eligible infants were offered either immediate or delayed repair after 55weeks corrected GA. Infants whose families elected to delay were followed until their hernia(s) clinically regressed, or until older than 55weeks. Families of 68 infants consented to delay repair. 23 infants (33.8%) had hernias that clinically regressed at median follow up from diagnosis of 14.1weeks. Univariate analysis demonstrated female sex as a significant predictor of hernia clinical regression (OR: 3.08; p = 0.046). Of the 45 infants who underwent repair, 84.4% safely progressed to 55weeks corrected GA prior to. Delaying inguinal hernia repair in this series of premature infants until after 55weeks corrected GA revealed that one third of hernias, especially in females, safely regressed upon follow-up examination.

Inguinal Hernia in Premature Infants.

Inguinal hernia is a common problem affecting infants in the NICU. As a group, preterm infants have the highest incidence of inguinal hernia and this risk increases as gestational age decreases. The etiopathologic factors leading to the development of an inguinal hernia are not clear and interventions to alter these factors have not been thoroughly investigated. Diagnosis of an inguinal hernia is often straightforward, but occasionally it may be difficult to determine if the hernia is strangulated or simply obstructed. Rarely, investigative modalities, such as ultrasonography, may be needed to rule out other potential causes. The ideal timing of surgical repair in this population is unknown and complicated by comorbid conditions and limited randomized controlled trials. During surgery, the choice of regional versus general anesthesia requires a team-based approach and studies have found that greater clinical experience is associated with lower morbidity. The techniques of hernia surgery range from open to laparoscopic repair and have been investigated in small prospective studies, while larger databases have been used to analyze outcomes retrospectively.

Management of Inguinal Hernia in Pediatric Age Group

Introduction: Incidence of indirect inguinal hernias in premature infants is reported to be as high as 30% with male predominance. Typically, inguinal hernia repairs are done under general anesthesia which has a high risk of post-operative complications, especially in the premature infant. The purpose of this study was to compare outcomes between early (neonatal) and delayed (older) inguinal hernia repair. Method: This is a prospective study in the department of pediatric surgery in alkhansaa Teaching Hospital Mosul / Iraq during a period from Jul 2018 to Dec 2019. All children with inguinal hernia were selected for the study and divided in two groups, those below one month and those above. Surgery is performed under general anesthesia with extracanalicular approach. Post-operative complications were observed and finally decided to discharge once patient is fit for discharge on the same day. Results: During the 18 months' period, we underwent 93 inguinal hernia repair those babies were divided into two groups, neonatal group (23 neonates) and older group (70 babies). The gender distribution ratio is 7.8 male :1 female. The side distribution among those babies in the neonatal group were 14,6 and 3 as right, left and bilateral respectively. In the neonatal group there were 9 babies presented with incarceration two (8.6%) of them shows testicular infarction and necrosis which necessitate excision at exploration while the other one atrophied in the period of follow up. We do not record any anesthetic complications or mortality in neonatal group in our period of study. Conclusion: Extracanalicular approach under general anesthesia is easy, safe, can be used for pediatric patients in neonatal age group with indirect inguinal hernia; with minimal complications, low recurrence rate.

A multi-institution analysis of predictors of timing of inguinal hernia repair among premature infants.

Inguinal hernias are common in premature infants, but there is substantial variation with regards to timing of repair. We sought to quantify and explain this variation. Cohort study of infants <34weeks gestation diagnosed with an inguinal hernia and discharged from one of 329 neonatal intensive units between 1998 and 2012. Multivariable logistic regression clustered by site was used to evaluate demographic, clinical, maternal, and socioeconomic variables associated with pre-discharge repair. A total of 8037 infants met study criteria, and 3230 (40%) received a pre-discharge repair. The frequency of pre-discharge repair varied by site from 9% to 84%, and increased over the study period from 20% in 1998 to 45% in 2012. Concurrent gastrostomy or fundoplication and lower socioeconomic status were associated with an increased odds of receiving a pre-discharge repair. There is substantial variation with regards to the timing of repair of inguinal hernias in premature infants, with an increasing number of infants receiving repair prior to hospital discharge over time. Concurrent gastrostomy or fundoplication and socioeconomic status are associated with timing of repair. IV.

Management of Inguinal Hernias in Premature Infants- Pre or Post Discharge- What Is Best?

Incidence of inguinal hernias in premature infants is reported to be as high as 30%, making inguinal hernia repair one of the most common surgeries performed in children. Frequency of inguinal hernia is inversely related to birthweight with rates highest in the very low birth weight infants. Due to multiple comorbidities, most pediatric surgeon weight to operate on premature infants until they have reached 1800-2000g. The purpose of this retrospective study is to determine optimal time period for repair of inguinal hernias in premature infants and to establish the use of regional anesthesia as standard of care. In a retrospective chart review of premature infants undergoing inguinal hernia repair from 1997 to 2016, 134 cases were reviewed. Anesthesia complications were limited to 0.07% in the caudal group and none in the spinal anesthesia group. Hernia recurrence rate in this study was minimal at 0.01%. Inguinal hernias in premature infants should be repaired as early as they are healthy enough to be transferred out of the intensive care unit, taking adequate oral nutrition and do not have further supplemental oxygen requirements. Regional anesthesia should be anesthesia of choice in premature infants.

Management of inguinal hernia in premature infants: 10-year experience

Aim:Debatable issues in the management of inguinal hernia in premature infants remain unresolved. This study reviews our experience in the management of inguinal hernia in premature infants.Materials and Methods:Retrospective chart review of premature infants with inguinal hernia from 1999 to 2009. Infants were grouped into 2: Group 1 had repair (HR) just before discharge from the neonatal intensive care unit (NICU) and Group 2 after discharge.Results:Eighty four premature infants were identified. None of 23 infants in Group 1 developed incarcerated hernia while waiting for repair. Of the 61 infants in Group 2, 47 (77%) underwent day surgery repair and 14 were admitted for repair. At repair mean postconceptional age (PCA) in Group1 was 39.5 ± 3.05 weeks. Mean PCA in Group 2 was 66.5 ± 42.73 weeks for day surgery infants and 47.03 ± 8.87 weeks for admitted infants. None of the 84 infants had an episode of postoperative apnea. Five (5.9%) infants presented subsequently with metachronous contralateral hernia and the same number of infants had hernia recurrence.Conclusions:Delaying HR in premature infants until ready for discharge from the NICU allows for repair closer to term without increasing the risk of incarceration. Because of low occurrence of metachronous hernia contralateral inguinal exploration is not justified. Day surgery HR can be performed in former premature infant if PCA is >47 weeks without increasing postoperative complications.

Inguinal hernia in premature infants

Inguinal hernia in premature infants

Contralateral inguinal exploration in premature neonates: is it necessary?

The purpose of this study was to review our management of neonatal inguinal hernias in premature infants over a 5-year period to ascertain any change in practice. Premature infants who underwent inguinal herniotomy between 2002 and 2006 were identified. Case notes were analyzed recording patient demographics, primary side, complications, recurrence and how many re-presented with a metachronous hernia. 172 preterm infants were identified: 162 males (94.2%) and 10 females (5.8%). Median gestation was 31 weeks (25-36.7). Eighteen (10.4%) were incarcerated. Median age at surgery was 66.5 days (0-284). Thirty-two (18.6%) had bilateral hernias. Of the 63 who underwent unilateral herniotomy, 9 (14.3%) re-presented with a metachronous hernia. Median time to returning was 24 days. The number of contralateral explorations decreased over the study period. The complication rate was 6.4%. Median follow-up was 2.83 years (0.33-5.4). This is one of the largest series showing the current practice in managing preterm infants with inguinal hernia. There are limitations to this study and the follow-up period is short. The value of contralateral groin exploration in premature neonates remains doubtful and we have shown that the overall practice has changed.

Optimal timing for repair of an inguinal hernia in premature infants

The aim of this study was to determine the optimal timing for inguinal herniotomy in premature infants treated in the neonatal intensive care unit. A two-institutional-center retrospective study was performed including 41 prematures at gestational age 28-35 weeks who underwent herniotomy within 1 week of diagnosis [short-waiting group (SWG), median 5 days, n = 25] or more than 1 week after diagnosis [long-waiting group (LWG), median 30.55 days, n = 16]. Gestational age, birthweight, post-conceptional age at diagnosis, age at diagnosis, post-conceptional age at surgery, age at surgery, weight at surgery, timing of surgery, operative time, and occurrence of incarceration, postoperative apnea, hernia recurrence, testicular atrophy, and hospital stay were compared between the two groups. Statistical analysis was performed using one-way ANOVA. Twelve preoperative episodes of incarceration occurred: three in the SWG and nine in the LWG (P < 0.05). Six infants had apnea postoperatively: four in the SWG and two in the LWG (P > 0.05). Follow-up revealed five hernia recurrences, one in the SWG and four in the LWG (P < 0.05); four testicular atrophies were found, one in the SWG and three in the LWG (P > 0.05). Early elective herniotomy should be considered in prematures in order to avoid perioperative morbidity and to reduce the risk of incarceration and subsequent testicular ischemia, and hernia recurrence.

Nutritional state and herniorrhaphy in premature infants.

The incidence of inguinal hernia in premature infants is significantly high, and the optimal timing for its correction is controversial. Furthermore, whether the nutritional status of neonates will alter hernia diagnosis and postoperative results has not been demonstrated. The aim of this study was to analyze the results of premature neonates who underwent inguinal hernia repair before hospital discharge, comparing clinical features and perioperative data of two distinct nutritional groups. It was verified that early inguinal hernia repair is feasible without an escalation in the incidence of complications, thereby reducing the risk of incarceration and avoiding subsequent hospitalization. Moreover, premature infants had similar postoperative outcomes regardless of their nutritional status.

Appendicite aiguë néonatale intra-herniaire

Acute neonatal appendicitis is a rare surgical emergency. Prognosis depends on early diagnosis and management. Case report. – A three and a half-month-old premature infant needed an urgent laparotomy because of an occlusive syndrome and sepsis with an inflammatory skin reaction. The per-operative diagnosis was suppurative acute appendicitis with local peritonitis, the appendix being strangulated into the inguinal hernia. Discussion. – Neonatal appendicitis represents 0.1% of all infantile appendicitis. Fifty percent of such cases occur in premature infants. Two clinical presentations exist, whose diagnosis is often made during surgery. The abdominal presentation (2/3 of the cases) can mimic necrotizing enterocolitis; the diagnosis is often late and evolution leads to diffuse peritonitis in the majority of the cases, while the mortality rate is higher than 50%. The intra-hernial presentation (1/3 of the cases), instead, is usually diagnosed and managed early due to the inguino-scrotal induration, while mortality rate is near zero. Conclusion. – The high frequency of inguinal hernia in premature infants should not mask the risk for intra-hernial appendicitis. Inguino-scrotal inflammation should evoke the diagnosis. Prognosis depends on early and urgent surgical management.

Predictors of postoperative respiratory complications in premature infants after inguinal herniorrhaphy

There is a significant incidence of inguinal hernia in premature infants and the optimal timing of repair is controversial. A high rate of postoperative respiratory complications has been reported in this group. In this study, the records of 47 premature infants (mean gestational age, 30.3 weeks) who underwent herniorrhaphy while still in the neonatal intensive care unit were reviewed in an effort to define those conditions that are independent risk factors for complications. Forty-three percent of infants had complications, including postoperative assisted ventilation (34%), episodes of apnea and/or bradycardia (23%), emesis and cyanosis with first feeding (6%), and requirement for postoperative reintubation (4%). Although low gestational age and postconceptual age at operation, low birth weight for gestational age, and preoperative ventilatory assistance were significantly associated with postoperative complications, only a history of respiratory distress syndrome/bronchopulmonary dysplasia (odds ratio 2.3), a history of patent ductus arteriosus (odds ratio 2.5), and low absolute weight at operation (odds ratio 3.5 for 1,000-g decrease) were independent risk factors for postoperative complication. Despite previous reports citing postconceptual age as the factor having the greatest impact on postoperative complications, these results indicate that a history of respiratory dysfunction and size at operation may be more important predictors of postoperative respiratory dysfunction in preterm infants.

A technique for fixation of the mobilized testis in neonatal herniorrhaphy

Dissection of the cord structures during herniorrhaphy in term infants may result in inadvertant mobilization of the testes from its gubernaculum attachments. Additionally, inguinal hernias in premature infants may be associated with ipsilateral cryptorchidism. However, creation of a subdartos pouch for fixation of the testis is generally unnecessary in this group of patients. We have devised a simple technique for fixation of the testis in this setting which will prevent subsequent testicular entrapment or torsion of the surgically mobilized or cryptorchid infantile testis.

Inguinal Hernias in Premature Infants Operated on Before Discharge From the Neonatal Intensive Care Unit

Sixteen premature infants were operated on during the two-year period from 1981 through 1982 for inguinal hernia prior to discharge from the hospital. There were no complications from the hernias before surgery and during administration of anesthesia and postoperative recovery, and no recurrences, would infections, or testicular atrophy was noted in long-term follow-up. In contrast to a controlled group of 11 full-term patients of this same age who were operated on as outpatients, the operating room time, operation time, and time in the recovery room were significantly increased for the premature infants. This resulted in a 22% increase in cost for the correction of the premature inguinal hernias. Analysis of the factors in repair of these hernias indicates that this increased cost will have to be accepted as part of the care of premature infants in neonatal intensive care units.

Inguinal Hernia in Premature Infants

I was interested to read the article by Harper et al. in the July 1975 issue on the incidence of hernias in premature infants weighing 1,000 gm or less at birth. According to these authors, no one thus far has recognized the remarkably high incidence of inguinal hernias (30%) in premature infants weighing less than 1,000 gm. I should like to point out, however, that a high incidence of such hernias in very-low-birth-weight premature infants was reported by Knox1 in 1959 and Walsh2 1962.

Strangulated inguinal hernias in premature infants

Strangulated inguinal hernias in premature infants

Inguinal hernias in premature infants

Summary 1. Inguinal hernias have been found in thirty-eight infants in a group of 830 premature infants, an incidence of 4.4 per cent. 2. This incidence is similar to that reported in full-term infants. 3. The age of gestation or the birth weight of the infant were not found to be important factors, except that the smallest infants (under 1,000 grams) have developed a larger percentage of hernias than any others. 4. Males predominate in the incidence (82 per cent). 5. Fifty-eight per cent of the hernias in both sexes were right-sided, 26 per cent left-sided, and 16 per cent bilateral. 6. Increased intraabdominal tension resulting from phimosis, constipation, cough, tympanites, anal or urethral constriction, vomiting, crying, and breath holding, are important factors in the development of hernia. Immature development of the abdominal and intestinal musculature are contributory factors. 7. Treatment should be conservative. Trusses, circumcision, and meatotomy where necessary and elimination of other causes of increased intraabdominal pressure are the essential forms of therapy. 8. Strangulation is a complication calling for immediate surgical measures.