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Systematic review of the risk of developing a metachronous contralateral inguinal hernia in children
1Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
Insights
This study found that 14 contralateral explorations are needed to prevent one metachronous contralateral inguinal hernia (MCIH) in children. Left-sided hernias carry a higher MCIH risk, with most occurring within five years post-surgery.
Area of Science:
- Pediatric Surgery
- Hernia Repair Outcomes
- Clinical Epidemiology
Background:
- Assessing the risk of metachronous contralateral inguinal hernia (MCIH) after unilateral inguinal hernia repair in pediatric patients is crucial for surgical decision-making.
- Understanding the long-term implications of open hernia repair is essential for optimizing patient management and preventing secondary procedures.
Purpose of the Study:
- To determine the incidence and risk factors associated with developing a metachronous contralateral inguinal hernia (MCIH) following open repair of a unilateral inguinal hernia in children.
- To evaluate the number of contralateral explorations needed to prevent a single case of MCIH.
Main Methods:
- A systematic review was conducted to identify relevant studies.
- Included studies focused on children undergoing open repair of a unilateral inguinal hernia without contralateral exploration, with follow-up data on MCIH development.
Main Results:
- Analysis of 49 papers involving 22,846 children revealed an overall MCIH incidence of 7.2%.
- Children with left-sided inguinal hernias exhibited a significantly higher risk (10.2%) compared to those with right-sided hernias (6.3%).
- The incidence of MCIH was similar between boys (6.9%) and girls (7.3%).
Conclusions:
- Approximately 14 contralateral explorations are necessary to prevent one MCIH in pediatric patients.
- The risk of MCIH remains consistent in early childhood, with a slight decrease observed after age 12.
- Most MCIHs manifest within the first five years after the initial unilateral inguinal hernia repair, with left-sided hernias posing a greater risk.
Background:
This study aims to establish the risk of developing a metachronous contralateral inguinal hernia (MCIH) following open repair of a unilateral inguinal hernia in children.
Methods:
A systematic review was performed using a defined search strategy. Studies in which children undergoing open repair of a unilateral inguinal hernia without contralateral exploration and who were followed up for MCIH development were included.
Results:
Of 5937 titles and abstracts screened, 154 full-text articles were identified for review; 49 papers were analysed with data on 22,846 children. The incidence of MCIH was 7.2 per cent overall, 6.9 per cent in boys and 7.3 per cent in girls (P = 0.381). Children with a left-sided inguinal hernia had a significantly higher risk of developing a MCIH than those with a right-sided hernia (10.2 versus 6.3 per cent respectively; P < 0.001).
Conclusion:
Overall, in both boys and girls, 14 contralateral explorations are required to prevent one metachronous hernia. The risk of developing a MCIH appears unchanged in early childhood, with a slight reduction after 12 years of age. Children with a left-sided hernia have the greatest risk of developing a contralateral hernia, but ten explorations are still required to prevent one metachronous hernia. Most MCIHs occur in the first 5 years after unilateral inguinal hernia repair.