Clinical regression of inguinal hernias in premature infants without surgical repair
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Published on: December 23, 2022
Mark A Fleming1, David F Grabski2, Emmanuel L Abebrese3
1Department of Surgery, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22908, USA. MAF2DE@hscmail.mcc.virginia.edu.
Insights
Delayed inguinal hernia repair in premature infants may lead to safe clinical regression. About one-third of hernias, particularly in females, regressed without surgery by 55 weeks corrected gestational age (GA).
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Hernia Research
Background:
- Inguinal hernias affect approximately 30% of premature infants.
- Early surgical repair is common due to incarceration risks.
- This study explores delaying repair in premature infants.
Purpose of the Study:
- To evaluate the safety and efficacy of delayed inguinal hernia repair in premature infants.
- To determine the rate of spontaneous hernia regression.
- To identify predictors of hernia regression.
Main Methods:
- A cohort of premature infants (<37 weeks GA) with inguinal hernias was identified.
- Families chose between immediate or delayed repair (after 55 weeks corrected GA).
- Infants with delayed repair were monitored for clinical regression or until >55 weeks corrected GA.
Main Results:
- 68 infants' families opted for delayed repair.
- 33.8% of hernias (23 infants) showed clinical regression at a median of 14.1 weeks follow-up.
- Female sex was a significant predictor of regression (OR: 3.08, p=0.046).
Conclusions:
- Delaying inguinal hernia repair until after 55 weeks corrected GA is a safe option for some premature infants.
- Approximately one-third of inguinal hernias in this cohort regressed spontaneously.
- Female infants demonstrated a higher likelihood of hernia regression.
Background:
The incidence of inguinal hernias in premature infants is approximately 30%. Due to concerns about a high risk of incarceration, early repair is commonly performed. We present a series of patients whose families opted to delay repair until after 55 weeks corrected gestational age (GA) and experienced safe clinical regression of their hernias.
Methods:
Between June 2015 and July 2020, premature infants (< 37 weeks GA) diagnosed with inguinal hernias on physical examination were identified. Families of eligible infants were offered either immediate or delayed repair after 55 weeks corrected GA. Infants whose families elected to delay were followed until their hernia(s) clinically regressed, or until older than 55 weeks.
Results:
Families of 68 infants consented to delay repair. 23 infants (33.8%) had hernias that clinically regressed at median follow up from diagnosis of 14.1 weeks. Univariate analysis demonstrated female sex as a significant predictor of hernia clinical regression (OR: 3.08; p = 0.046). Of the 45 infants who underwent repair, 84.4% safely progressed to 55 weeks corrected GA prior to.
Conclusion:
Delaying inguinal hernia repair in this series of premature infants until after 55 weeks corrected GA revealed that one third of hernias, especially in females, safely regressed upon follow-up examination.
