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Assessment of the delayed repair of uncomplicated inguinal hernias in infants
S N Botes1, J Edge1, J P Apffelstaedt2
1Division of General Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
Insights
Delayed repair of infant inguinal hernias is safe. This approach avoids strangulation and does not increase complications, offering a viable alternative to immediate surgery when theatre time is limited.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- Infant inguinal hernias often require urgent surgical repair due to strangulation risk.
- Limited operating theatre availability can delay necessary surgical interventions.
- This study evaluates outcomes of discharging infants home for delayed elective hernia repair.
Purpose of the Study:
- To assess the safety and efficacy of delayed surgical repair for uncomplicated infant inguinal hernias.
- To compare complication rates and hospital stay between immediate and delayed repair groups.
- To determine if delaying surgery increases the risk of incarceration or strangulation.
Main Methods:
- Retrospective audit of infant inguinal hernia cases from 2010 to 2015.
- Exclusion of incomplete records and late repairs (after age 1).
- Comparison of immediate vs. delayed repair groups on incarceration, strangulation, perioperative complications, and hospital stay.
Main Results:
- A mean delay of 8.78 weeks for surgery in the delayed group.
- No strangulation occurred in the delayed repair group while awaiting surgery.
- Similar rates of surgical and anesthetic complications between immediate (10% and 5.7%) and delayed (4.7% and 3.6%) groups.
- Incarceration rate of 4.1% in the delayed group post-discharge.
- No significant difference in postoperative hospital stay (1.43 vs. 1.3 days).
Conclusions:
- Delayed repair of uncomplicated infant inguinal hernias, up to 2 months, is associated with a low risk of incarceration.
- This approach does not elevate the risk of strangulation or other perioperative complications.
- Delayed repair is a safe option when immediate surgery is not feasible due to resource limitations.
Background:
Potential strangulation of infant inguinal hernias is the main indication for their urgent repair. Lack of theatre time delays repair and prolongs hospitalisation. We report a series of patients with uncomplicated hernias who were discharged home to have their elective surgery at a later stage and assessed the outcomes of this approach.
Methods:
A retrospective audit was performed of all infants with an inguinal hernia from January 2010 to June 2015. Incomplete records and infants operated after their first birthday were excluded. Two groups were identified; immediate surgery for infants with uncomplicated hernias, and delayed surgery for infants with uncomplicated hernias. Incarceration/strangulation rates in the interim period were documented for the delayed group, and comparison made between the groups regarding perioperative and anaesthetic complications and length of postoperative hospital stay.
Results:
The mean time delay between diagnosis and repair was 8.78 weeks. None of the hernias in the delay group strangulated while awaiting repair. There was no significant difference in the perioperative complications between the two groups. Out of the 70 cases in the immediate repair group, there was 7 (10%) surgical and 4 (5.7%) anaesthetic complications. The delayed group (169 infants) had 8 (4.7%) surgical and 6 (3.6%) anaesthetic complications. The incarceration rate after being discharged home was 4.1%. This group of infants had no anaesthetic or surgical complications. Length of hospital stay postoperatively was 1.43 days in the immediate group and 1.3 in the delayed group (p = .485).
Conclusion:
Delayed repair, up to 2 months later, for uncomplicated infant hernia carries a small risk of incarceration but does not increase the rate of strangulation or other complications.
