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A prospective study of neonatal inguinal herniotomy: the problem of the postoperative hydrocele
Brian W Davies1, Nia Fraser, Azad S Najmaldin
1Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Insights
Complications after neonatal inguinal herniotomy (IH) are higher in small boys. Postoperative hydrocele in these infants often resolves spontaneously, suggesting an expectant approach if no recurrent hernia is evident.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Urology
Background:
- Neonatal inguinal herniotomy (IH) is common in male infants.
- Previous studies indicate a higher complication rate in neonates undergoing IH.
- The incidence and natural history of postoperative hydrocele after IH in low-birth-weight infants remain undescribed.
Purpose of the Study:
- To investigate the incidence and natural history of postoperative hydrocele following neonatal inguinal herniotomy (IH) in male infants weighing less than 3 kg.
- To assess the overall complication rate in this specific patient population.
Main Methods:
- Prospective follow-up study of consecutive male infants weighing < 3 kg undergoing IH.
- Scheduled follow-up examinations for at least 1 year post-surgery.
- Data collected on recurrent hernias, testicular atrophy, testicular ascent, and hydroceles.
Main Results:
- Of 37 eligible infants (46 IHs), 4 boys (14%) developed 5 ipsilateral hydroceles (11% of IHs).
- Recurrent hernias occurred in 4%, atrophic testes in 4%, and iatrogenic testicular ascent in 2%.
- Hydroceles were managed expectantly (aspiration or spontaneous resolution) in 3 cases, with no recurrence of patent processus vaginalis.
Conclusions:
- The complication rate for neonatal IH in low-birth-weight infants is significantly higher than in older boys.
- Postoperative hydrocele in this cohort may represent fluid accumulation in the hernia sac.
- An expectant management approach is recommended for hydroceles post-neonatal IH, absent evidence of recurrent inguinal hernia.
Abstract:
Previous studies have reported an increased incidence of complications following neonatal inguinal herniotomy (IH) in boys. The incidence and natural history of postoperative hydrocele in such cases has not been described. A prospective follow-up study of a consecutive series of male infants weighing less than 3 kg at the time of IH was undertaken. Regular follow-up examinations were scheduled for at least 1 year. Thirty-eight boys weighing less than 3 kg underwent IH during an 18-month period. One subsequently died from complications of prematurity. Complete follow-up data were available for 29/37 (78%) patients, yielding a total of 46 IHs. There were 2 recurrent hernias (4%), 2 unequivocally atrophic testes (4%), and 1 iatrogenic testicular ascent (2%). Five ipsilateral hydroceles complicated the postoperative course of 4 boys (14% of patients, 11% of herniotomies). Two of these were explored, but in neither case was a recurrent/residual patent processus vaginalis found. One hydrocele was aspirated without recurrence, and the remaining 2 resolved spontaneously. The complication rate in small infants undergoing neonatal IH is significantly higher than in older boys. The presence of a hydrocele after neonatal IH may simply reflect the accumulation of fluid in the distal hernia sac and, provided there is no evidence of a recurrent inguinal hernia, an expectant approach is recommended.