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Contralateral inguinal exploration in premature neonates: is it necessary?
Mairi Steven1, Owen Greene, Adam Nelson
1Department of Surgical Pediatrics, Royal Hospital for Sick Children, Dalnair Street, Glasgow, G3 8SJ, UK. mairisteven@doctors.org.uk
Purpose:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
