Prematurity, not age at operation or incarceration, impacts complication rates of inguinal hernia repair
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Robert Baird1, Suad Gholoum, Jean-Martin Laberge
1Division of Pediatric General Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada H3H 1P3.
Insights
Prematurity, not age or incarceration, impacts complication rates in pediatric inguinal hernia repair (IHR). Premature infants face higher risks, informing surgical consent discussions for this common procedure.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Neonatal Care
Background:
- Inguinal hernia repair (IHR) is the most frequent pediatric surgical procedure.
- Postoperative complications are known, but determinants like prematurity and age require further examination.
Purpose of the Study:
- To investigate if prematurity and age at operation influence postoperative complication rates following pediatric inguinal hernia repair.
Main Methods:
- Retrospective review of 268 children under 2 years undergoing IHR (2004-2007) with ≥1-year follow-up.
- Patients grouped by age at diagnosis (0-104 weeks) and prematurity status.
- Complications categorized as major (vas injury, recurrence, testicular atrophy) or minor (wound infection, high testicle, hydrocele).
Main Results:
- Overall, 5.2% major and 9.7% minor complications were observed.
- Younger patients (<26 weeks) had significantly more major and minor complications (P < .005).
- Premature infants (<26 weeks) experienced higher complication rates (27.7%) compared to term infants (12.1%, P = .01).
Conclusions:
- Prematurity is a significant determinant of postoperative complications after pediatric inguinal hernia repair.
- Age at operation and hernia incarceration were not found to be significant factors.
- Findings emphasize the importance of discussing prematurity risks during informed consent for IHR.
Purpose:
Inguinal hernia repair (IHR) remains the most common procedure in pediatric surgery. Although postoperative sequelae are well described, we examined if prematurity and age were important determinants of postoperative complications.
Methods:
A retrospective review of children younger than 2 years undergoing IHR from 2004 to 2007 was performed, with a minimum of 1-year follow-up. Patients were segregated into groups based on age at diagnosis (A, 0-3; B: 4-26; C: 27-52; D: 53-104 weeks), with or without prematurity. Incarceration rates were investigated. Complications were categorized as major (vas injury, recurrence, testicular atrophy) or minor (wound infection, "high" testicle, hydrocele) and compared.
Results:
Two hundred sixty-eight patients were analyzed (98 premature), with 14 major complications (5.2%) and 26 (9.7%) minor complications overall. Groups A and B accounted for more major (12/14) and minor complications (22/26) when compared with groups C and D (P < .005). In patients less than 26 weeks (groups A and B), premature infants had more complications than term infants (27.7% vs 12.1%, P = .01). Of 22 patients with incarcerated hernias, 2 (9.1%) had major complications (P < .5 vs nonincarcerated patients).
Conclusions:
Our study suggests that prematurity, rather than age at operation or incarceration, affects complication rates after IHR. This information should be used to frame the discussion of informed consent for this commonly performed procedure.
