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Very low birth weight is an independent risk factor for emergency surgery in premature infants with inguinal hernia
Barry de Goede1, Joost Verhelst1, Bob J van Kempen2
1Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Insights
Optimal management for inguinal hernia repair in premature infants is debated. Early, elective repair is recommended, especially for very low birth weight infants, to reduce complications and recurrence risks.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes
Background:
- Inguinal hernia repair in premature infants is commonly delayed until a specific weight or age is reached.
- However, the optimal management strategy remains a subject of ongoing clinical discussion.
- This study aimed to gather evidence to inform the best approach for inguinal hernia repair in this vulnerable population.
Purpose of the Study:
- To evaluate the optimal management strategy for inguinal hernia repair in premature infants.
- To identify risk factors associated with incarceration and emergency surgery.
- To compare outcomes between elective and emergency hernia repair procedures.
Main Methods:
- Retrospective analysis of 142 premature infants with inguinal hernia treated within 3 months of birth (2010-2013).
- Primary outcomes included rates of incarceration and subsequent emergency surgery.
- Multivariate analysis using a Cox proportional hazards model identified independent risk factors for emergency procedures.
Main Results:
- Over half (55.6%) of premature infants presented with symptomatic inguinal hernias, requiring emergency surgery in 55.7% of cases.
- Emergency operations had significantly higher complication rates (27.3%) and recurrence rates (13.6%) compared to elective repairs (10.2% and 2.0%, respectively).
- Very low birth weight (≤1,500 g) was identified as an independent risk factor for emergency surgery (Hazard Ratio 2.7).
Conclusions:
- Incarceration affects more than half of premature infants with inguinal hernias.
- Very low birth weight infants face a threefold increased risk of requiring emergency procedures.
- Elective inguinal hernia repair is advised, particularly for very low birth weight premature infants, to minimize complications and recurrence.
Background:
Common surgical knowledge is that inguinal hernia repair in premature infants should be postponed until they reach a certain weight or age. Optimal management, however, is still under debate. The objective of this study was to collect evidence for the optimal management of inguinal hernia repair in premature infants.
Study Design:
In the period between 2010 and 2013, data for all premature infants with inguinal hernia who underwent hernia correction within 3 months after birth in the Erasmus MC-Sophia Children's Hospital, Rotterdam were analyzed. Primary outcomes measures were the incidences of incarceration and subsequent emergency surgery. In a multivariate analysis, Cox proportional hazards model served to identify independent risk factors for incarceration requiring an emergency procedure.
Results:
A total of 142 premature infants were included in the analysis. Median follow-up was 28 months (range 15 to 39 months). Seventy-nine premature infants (55.6%) presented with a symptomatic inguinal hernia; emergency surgery was performed in 55.7%. Complications occurred in 27.3% of emergency operations vs 10.2% after elective repair; recurrences occurred in 13.6% vs 2.0%, respectively. Very low birth weight (≤1,500 g) was an independent risk factor for emergency surgery, with a hazard ratio of 2.7 in the Cox proportional hazards model.
Conclusions:
More than half of premature infants with an inguinal hernia have incarceration. Those with very low birth weight have a 3-fold greater risk of requiring an emergency procedure than heavier premature infants. Emergency repair results in higher recurrence rates and more complications. Elective hernia repair is recommended, particularly in very low birth weight premature infants.
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