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Incisional hernia in pediatric surgery - experience at a single UK tertiary centre
Dhanya Mullassery1, Ami Pedersen1, Andrew Robb1
1Department of Paediatric Surgery, Addenbrooke's Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
Insights
Pediatric incisional hernias (IH) are uncommon but significant, particularly after stoma closure for necrotizing enterocolitis (NEC). This study analyzed IH incidence and treatment in children, finding a 2.3% rate in infants under six months.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Hernia Surgery
Background:
- Incisional hernia (IH) is a known complication of abdominal surgery in adults, but data in children is limited.
- Understanding the incidence and risk factors for pediatric IH is crucial for improving surgical outcomes.
Purpose of the Study:
- To determine the incidence of incisional hernias (IH) in pediatric patients.
- To analyze the treatment and outcomes of IH repair in children.
Main Methods:
- A retrospective review of pediatric patients undergoing IH repair over seven years at a UK tertiary center.
- Data collection included patient demographics, primary surgery details, time to IH diagnosis, and repair outcomes.
Main Results:
- Twenty-one pediatric patients underwent IH repair, with an overall incidence of 2.3% in infants under six months undergoing primary abdominal surgery.
- Necrotizing enterocolitis (NEC) was the most common indication for primary surgery, and stoma closure had the highest IH rate (7.5%).
- Median age at repair was 7.9 months, with 81% diagnosed within one year of the initial procedure.
Conclusions:
- The incidence of incisional hernias in children is low but clinically relevant.
- Pediatric IH is most frequently diagnosed after stoma closure for NEC.
Aims:
Incisional hernia (IH) is a recognized complication of open and laparoscopic visceral surgery, with reported rates of 10-50% in adult surgical literature. There is a paucity of data relating to incisional hernias in children. The aim of our study was to analyze the incidence and treatment of IH in children.
Methods:
Retrospective review of all patients admitted for incisional hernia repair at a tertiary pediatric surgical centre in the UK more than a 7-year period was performed. Data collected included age at initial surgery, time to IH repair, and type of IH repair and postoperative complications.
Results:
Twenty one patients (14 male) underwent IH repair during the study period. The incidence of IH among children who had primary abdominal surgery in our institution less than the age of 6months was 2.3%. Median age at repair was 7.9months (range: 18days-5years). Median time from primary surgery to diagnosis of IH was 2months (range 0day-3years), with 81% (17/21) diagnosed within 1year of the preceding abdominal procedure. The most common pathology necessitating the primary operative procedure was necrotising enterocolitis (n=9) in babies of gestational age less than 30weeks. The highest rates of IH were noted in infants following closure of stoma (7.5%) and pyloromyotomy (2.52%). Primary closure was undertaken in all cases. Two children had recurrence of IH, one of which underwent surgical repair.
Conclusions:
Incidence of IH in children is low but significant. IH was most commonly diagnosed following closure of stoma for NEC in this study.
