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Frequency and complications of inguinal hernia repair in giant omphalocele
Emily A Partridge1, William H Peranteau1, Alan W Flake1
1The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104.
Insights
Giant omphalocele patients have a high incidence of inguinal hernias (IH), particularly males. Early repair with the Bassini method is recommended to reduce complications like incarceration and recurrence.
Area of Science:
- Pediatric Surgery
- Neonatal Surgery
- Abdominal Wall Defects
Background:
- Giant omphalocele (GO) presents unique anatomical challenges and comorbidities.
- Large inguinal hernias (IH) are a recognized complication in GO patients, but their characteristics are not well-documented.
Purpose of the Study:
- To determine the incidence and complication rates of inguinal hernias (IH) in patients with giant omphalocele (GO).
- To evaluate the association of IH with patient demographics and outcomes in the GO population.
Main Methods:
- Retrospective chart review of GO patients (2004-2012) with at least 12 months follow-up.
- Statistical analysis using Fisher's exact test and Mann-Whitney test (p<0.05).
Main Results:
- 41% of GO patients developed IH; significantly associated with male gender (p<0.0001).
- Incarceration occurred in 19% of IH cases.
- Recurrence rates were high (6/7) after high ligation alone, but low after Bassini repair. Postoperative complications included ileus, testicular issues, and one death.
Conclusions:
- High incidence of IH in GO patients necessitates careful monitoring.
- The prevalence of incarceration and recurrence supports early inguinal herniorrhaphy using the Bassini repair before hospital discharge.
Purpose:
Giant omphalocele (GO) is a challenging problem owing to aberrant anatomy and complex comorbidities. Large inguinal hernias (IH) are known to occur in this population, but have not been well described in the literature. We sought to characterize rates and complications of IH in GO patients.
Methods:
A retrospective chart review was performed on all patients with the diagnosis of GO from 2004 to 2012, with a minimum follow-up period of 12 months. Statistical significance was calculated using Fisher's exact test and Mann-Whitney test (p<0.05).
Results:
A total of 51 giant omphalocele patients were born during the 8-year study period, with IH diagnosed in 21 patients (41%). IH was not associated with gestational age, birth weight, or method of GO closure, but was significantly associated with male gender (p<0.0001). Incarceration occurred in 4 patients (19%). Recurrence was noted in 7 cases, with 6/7 recurrences following repair by high ligation of the sac alone. All recurrences were repaired with the Bassini repair. Postoperative complications were noted in 7 patients (33%) and included prolonged ileus following incarceration, testicular tethering, testicular atrophy, persistent hydrocele, and death following acute incarceration.
Conclusions:
Our study suggests a high incidence of IH in GO patients. The prevalance of incarceration and recurrences in these patients support a role for inguinal herniorrhaphy via a Bassini repair prior to initial hospital discharge.
