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Emergency presentation of inguinal hernia in childhood--treatment strategy. A follow-up study
H J Gyrtrup1, S Mejdahl, E Kvist
1Department of Surgery, Sundby Hospital, Copenhagen, Denmark.
Insights
This study on irreducible inguinal hernia in children found that conservative treatment is often successful. Prompt surgical intervention is recommended when reduction is not possible to minimize complications and recurrence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Irreducible inguinal hernia is a common surgical emergency in children.
- Delayed treatment can lead to complications such as incarceration and strangulation.
Purpose of the Study:
- To evaluate the outcomes of treating irreducible inguinal hernia in pediatric patients.
- To suggest an optimal treatment strategy to reduce recurrence and infection rates.
Main Methods:
- Retrospective study of 95 cases of irreducible inguinal hernia in 93 children.
- Analysis of treatment approaches: immediate surgery, delayed surgery, and conservative management.
- Follow-up assessment of complications, infections, and recurrence rates.
Main Results:
- 60% of patients were successfully treated with conservative measures upon admission.
- Low rates of complications were observed: 2.8% infection rate and 12.3% recurrence rate.
- Minor complications included wound hematoma and aspiration pneumonia.
Conclusions:
- Conservative management with gentle taxis and sedation is effective for many pediatric irreducible inguinal hernias.
- Immediate surgery is advised if reduction is not achieved.
- A structured approach involving observation post-reduction and elective herniotomy can optimize outcomes.
Abstract:
This article presents a retrospective study of 95 cases of irreducible inguinal hernia in 93 children (median age 0.5 years; range 0-13 years) admitted with this diagnosis. In 38 cases operations were performed without delay, in 51 from 12 to 48 hours after admission, and in 6 cases at a later stage. Thus, a total of 57 patients (60%) could be treated with conservative measures at the time of admission. Three instances of minor wound haematoma which did not require treatment and two instances of pneumonia caused by aspiration were recorded. Eighty-three patients could be traced, 70 of whom responded to our questionnaire. The number of infections was 2 (2.8%) and the number of recurrences was 9 (12.3%). In order to reduce the recurrence and infection rates in emergency cases of irreducible inguinal hernia in childhood, the following treatment strategy is suggested: primarily gentle taxis, combined with sedation, if necessary. If reduction is impossible, surgery should be performed without delay. If reduction is achieved, the child can be discharged after 24 hours of observation and readmitted after one week for elective out-patient herniotomy.