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Risk of incarceration in children with inguinal hernia: a systematic review

C S Olesen1, L Q Mortensen2, S Öberg2

  • 1Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark. christofferskovolesen@gmail.com.

Hernia : the Journal of Hernias and Abdominal Wall Surgery
|January 15, 2019
PubMed

Insights

Delaying surgery for pediatric inguinal hernias carries a substantial risk of incarceration, particularly in preterm infants. Unnecessary surgical delays are generally not supported, though individual assessments are crucial.

Area of Science:

  • Pediatric Surgery
  • Surgical Outcomes
  • Hernia Management

Background:

  • Inguinal hernia repair in children is typically recommended due to concerns about incarceration.
  • This study evaluated the risks associated with delayed or no surgical intervention for pediatric inguinal hernias.

Purpose of the Study:

  • To assess the risk of incarceration and strangulation in children with inguinal hernias managed with delayed or no surgery.
  • To inform clinical decision-making regarding the timing of surgical repair.

Main Methods:

  • A systematic literature search was performed across three databases.
  • Included studies focused on children (mostly ≤10 years) with inguinal hernias undergoing non-acute surgery or watchful waiting.
  • Outcomes assessed included incarceration, strangulation, and postoperative complications; study designs encompassed RCTs, non-RCTs, and observational studies.

Main Results:

  • Twenty-two studies involving 14,959 children were analyzed, primarily reporting elective repairs.
  • The median wait time for surgery was 46 days.
  • Crude incarceration rates were 7% overall and 11% in preterm children, with 1% rates for testicular atrophy and recurrence.

Conclusions:

  • A significant risk of incarceration exists for children awaiting inguinal hernia surgery.
  • Unnecessary delays in surgical intervention are generally discouraged.
  • Surgeons must weigh the potential benefits against the risk of incarceration in individual cases where delaying surgery is considered.
Abstract

Keywords:
ChildrenDelayed repairElective surgeryIncarcerationInguinal herniaWatchful waiting

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