Optimal timing for inguinal hernia repair in premature infants: a systematic review and meta-analysis
Pourya Masoudian1, Katrina J Sullivan2, Hisham Mohamed2
1Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5.
Insights
Repairing inguinal hernias in premature infants before neonatal intensive care unit (NICU) discharge may increase recurrence and respiratory issues. However, early repair does not significantly impact incarceration or surgical complications.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Clinical Outcomes Research
Background:
- The optimal timing for inguinal hernia repair in premature infants is debated.
- This study assesses clinical outcomes of repair before versus after neonatal intensive care unit (NICU) discharge.
Purpose of the Study:
- To compare the clinical effects of early (before NICU discharge) versus delayed (after NICU discharge) inguinal hernia repair in premature infants.
Main Methods:
- A systematic review and meta-analysis of comparative studies was conducted.
- Searches included MEDLINE, Embase, CINAHL, and CENTRAL up to July 2018.
- Six studies involving 1761 premature infants were analyzed.
Main Results:
- No significant difference was found in incarceration or surgical complication rates between early and delayed repair.
- Early repair was associated with significantly increased odds of hernia recurrence.
- Early repair also showed increased odds of respiratory difficulty compared to delayed repair.
Conclusions:
- Repairing inguinal hernias before NICU discharge may elevate the risk of recurrence and respiratory complications.
- The timing of repair did not significantly affect incarceration or surgical complication rates.
Background:
The optimal timing of repair for inguinal hernia in premature infants remains a controversial topic. Our objective was to assess the clinical effects of inguinal hernia repair done before or after neonatal intensive care unit (NICU) discharge.
Methods:
MEDLINE, Embase, CINAHL, and CENTRAL were searched in July 2018. Publications comparing clinical outcomes of the premature infants with inguinal hernia repair before (early) and after (delayed) NICU discharge were identified. Two reviewers independently screened studies, extracted data, and assessed for quality. Results were pooled using random effects meta-analysis.
Results:
Of 640 publications identified, six comparative studies assessing a total of 1761 premature infants were included. Meta-analysis indicated no statistically significant difference in incarceration rate (odds ratio (OR) 2.15, 95% confidence interval (CI) 0.83-5.58, I2 = 0%), surgical complications (OR 2.36, 95% CI 0.66-8.41, I2 = 0%) and other secondary complications. However, the odds of recurrence and respiratory difficulty was significantly increase in the early group compared to delayed (OR 4.12, 95% CI 1.17-14.45, I2 = 0%; OR 3.59, 95% CI 1.10-11.75, I2 = 42%).
Conclusions:
Repair of inguinal hernia in premature infants before NICU discharge may increase the odds of recurrence, but not incarceration or surgical complications.
Level Of Evidence:
Level III.
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