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Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review
Sigmund H Ein1, Ike Njere, Arlene Ein
1Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. a_ein@istar.ca
Insights
This large pediatric inguinal hernia study challenges common myths, suggesting premature infants need earlier repair and routine contralateral exploration is unnecessary. Teenage recurrence rates were notably higher than previously thought.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- Pediatric inguinal hernias are common, with established surgical guidelines.
- Myths and teachings surrounding their management persist.
- A single-surgeon, large-scale study offers a unique perspective on these established norms.
Purpose of the Study:
- To evaluate and potentially refute long-held beliefs regarding pediatric inguinal hernias.
- To analyze demographic and clinical data from a substantial cohort of pediatric patients.
- To provide evidence-based insights into optimal surgical timing and approach.
Main Methods:
- Retrospective chart review of 6361 pediatric patients operated on for inguinal hernias.
- Data collection spanned from July 1969 to January 2004.
- Patients ranged from premature infants to 18 years old, all managed by a single pediatric surgeon.
Main Results:
- The study included 6361 pediatric inguinal hernias (5:1 male:female ratio).
- Incarceration occurred in 12%, with 5% developing contralateral hernias and 1.2% experiencing recurrence.
- Key findings include higher recurrence in teenagers and a need for earlier repair in premature infants.
Conclusions:
- Early repair is recommended for inguinal hernias in premature infants.
- Routine contralateral groin exploration is not indicated in pediatric inguinal hernia cases.
- Teenage recurrence rates for inguinal hernias are significantly higher than the overall series average.
Purpose:
This study, by its mere size and uniformity (1 pediatric surgeon), aims to corroborate or refute the teachings and myths of the pediatric inguinal hernia.
Methods:
From July 1969 to January 2004, 6361 infants and children with inguinal hernias were seen, operated on, and followed by the senior author. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients. The hospital's research ethics board approved of this study.
Results:
The ages ranged from premature to 18 years (mean age, 3.3 years) with a male-to female ratio of 5:1. There were 59% right, 29% left, and 12% bilateral hernias (almost all indirect). Hydroceles were found in 19%. Incarceration occurred in 12%. A modified Ferguson repair was used. An opposite-side hernia developed in 5%, 95% within the first 5 years, and was not sex or age specific. There were 1.2% recurrences, 96% within 5 years. Thirteen percent had ventriculo-peritoneal shunts, 1.2% wound infections, and 0.3% testicular atrophy. There were no postoperative deaths. One percent had a documented hernia disappearance.
Conclusions:
Three of our results have not corresponded with previous teachings and myths: (1) a hernia of a premature baby should be fixed sooner than later; (2) routine contralateral groin exploration is not indicated in any situation; and (3) teenage recurrence rate is 4 times greater than the overall series.
