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[Inguinal hernia in preterm infants - therapeutic problem for neonatologist, anaesthesiologist and paediatric
Ewa Sawicka1, Maria Boczar, Joanna Stankiewicz
1Klinika Chirurgii Dzieci i Młodziezy, Instytut Matki i Dziecka, ul. Kasprzaka 17a, Warszawa, Poland. e.sawicka@chello.pl
Insights
Surgical repair of inguinal hernia in preterm infants is recommended before discharge, even with anesthesia risks. Spinal anesthesia is a safe alternative for these vulnerable infants, particularly those with chronic lung disease.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Anesthesiology
Context:
- Inguinal hernia presents significant therapeutic challenges in preterm infants due to anesthesia risks and immaturity.
- Preterm infants often experience various complications related to prematurity, impacting surgical management.
Purpose:
- To evaluate perioperative challenges and outcomes of surgical repair for inguinal hernia in preterm infants.
- To assess the safety and efficacy of different anesthesia methods in this population.
Summary:
- The study analyzed 21 preterm infants undergoing inguinal hernia repair, with 23 operations performed.
- While some infants required general anesthesia, spinal anesthesia proved to be a safe alternative, especially for those with chronic lung disease.
- No hernia recurrences were observed during follow-up, indicating successful surgical outcomes.
Impact:
- Highlights the importance of considering surgical intervention for inguinal hernias in preterm infants prior to discharge.
- Supports the use of spinal anesthesia as a viable and safe option, potentially reducing risks associated with general anesthesia in preterm neonates.
Unlabelled:
Inguinal hernia in preterm infants is a difficult therapeutic problem because of the risk of anaesthesia and the immaturity of the baby. Despite of high risk of perioperative complications surgical repair of the hernia should be considered before discharge.
Aim:
evaluation of the perioperative problems in the preterm infants with inguinal hernia.
Material And Methods:
evaluation was performed in 21 preterm infants (gestational age 23-36 weeks, birth weight 450-1370 g) operated because of inguinal hernia between 2002-2007. Various problems related to prematurity were confirmed in all patients. Incarcerated hernia were operated on in 5 patients, in 16 neonates hernia repair was performed as elective surgery. In two of them, few weeks after unilateral hernia repair, operation on the other side was performed because of incarceration. Nine infants were qualified for general anaesthesia, fourteen for spinal anaesthesia. Indications for surgical treatment, method of anaesthesia and early postoperative results were analysed with reference to various problems connected with prematurity such as intraventricular haemorrhage and chronic lung disease.
Results:
inclusively 23 operations were performed in 21 infants (gestational age 36-47 weeks, weight 1130 -2750 g). Four of fourteen infants preliminary qualified for spinal anaesthesia turned into general anaesthesia. There were not any problems during the operations. Two patients required short ventilatory support (both with general anaesthesia because of incarcerated hernia). During a follow up examination recurrence of the hernia was not observed in any of the patients.
Conclusion:
despite of high risk of perioperative complications in preterm infants, surgical repair of the inguinal hernia should be considered before discharge. Spinal anaesthesia is a safe alternative for general anaesthesia in preterm infants especially for infants with chronic lung disease.
