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Comparative Analysis of Laparoscopic Inguinal Hernia Repair in Neonates and Infants
Caoimhe M Walsh1, Jessica Ng, Amulya K Saxena
1Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Insights
Laparoscopic inguinal hernia repair in infants showed no difference in recurrence rates between younger and older groups. Preoperative hemoglobin levels are crucial for optimizing surgical scheduling in infants under 3 months.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Neonatal Care
Background:
- Laparoscopic inguinal hernia repair (LIHR) is a common procedure in infants.
- Comparison of outcomes in infants aged 3 months and below versus those above 3 months corrected age is essential.
Purpose of the Study:
- To compare the outcomes of LIHR in infants younger than 3 months (corrected age) with those older than 3 months.
- To identify perioperative factors influencing outcomes in younger infants.
Main Methods:
- Retrospective analysis of 80 infants undergoing LIHR (2013-2018).
- Comparison between infants ≤3 months and >3 months corrected age.
- Data included demographics, prematurity, anesthetic time, complications, and recurrence.
Main Results:
- No significant difference in hernia recurrence rates between the two age groups.
- Infants ≤3 months had a significantly longer median anesthetic time (93 min vs. 83 min).
- No perioperative complications or mortality observed; one recurrence.
Conclusions:
- LIHR outcomes are comparable between infants ≤3 months and >3 months corrected age.
- Preoperative hemoglobin levels require careful management in infants ≤3 months.
- Anesthetic time is longer in younger infants, necessitating tailored preoperative assessment.
Background:
This study analyzed our cohort of infants (age below 12 mo) who underwent laparoscopic inguinal hernia repair (LIHR), comparing those 3 months and below (corrected premature) to above 3 months (term infants) corrected age at the time of surgery.
Materials And Methods:
Retrospective analysis of a single surgeon and associated trainees' experience of LIHR in infants below 12 months over a 5-year period (2013-2018) was performed. The operative technique involved a 5-mm scope and 3-mm instruments for herniorrhaphy with 4/0 Prolene purse-string suture. Data collected included patient demographics, prematurity (<37 wk), corrected age and weight at surgery, preoperative hemoglobin level, comorbidities, anesthetic time, major perioperative complications, and inguinal hernia recurrence. A comparison was made between those operated at 3 months and below and above 3 months corrected age. Perioperative issues affecting infants 3 months and below were identified and analyzed. Statistical analysis includes T test and Fisher exact test (P<0.05 significance).
Results:
Eighty infants underwent LIHR (age below 12 mo), of which 67 (84%) were male with a median corrected age of 10.5 (range 2.5 to 44) weeks, the median weight of 5.5 kg (range 2.1 to 10.8). A total of 47 (59%) infants had a unilateral inguinal hernia repair and 33 (41%) had a bilateral repair. The median anesthetic time was significantly greater for infants 3 months and below at 93 (range 61 to 125) minutes, compared with 83 (range 47 to 146) minutes for the above 3 months age group (P=0.001) There were no perioperative complications or mortality. One patient had a recurrence of an inguinal hernia. Low hemoglobin levels, comorbidities, and extreme prematurity required more attention during preoperative assessment and postoperative management.
Conclusions:
Comparable cohorts demonstrated no significant difference in recurrences despite significant differences in weight and median anesthetic time. Preoperative hemoglobin is an important factor that needs to be addressed in infants 3 months and below for scheduling the procedure date (transfusion vs. iron supplementation).
