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High incidence of inguinal hernias among patients with congenital abdominal wall defects: a population-based
Arimatias Raitio1, Nelly Kalliokoski2, Johanna Syvänen2
1Department of Paediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland. arimatias.raitio@fimnet.fi.
Insights
Infants with congenital abdominal wall defects have a higher risk of inguinal hernia (IH). This finding supports the theory of elevated intra-abdominal pressure impacting processus vaginalis closure, necessitating parental awareness and early follow-up.
Area of Science:
- Pediatric Surgery
- Neonatology
- Congenital Malformations
Background:
- Inguinal hernia (IH) is a common pediatric surgical condition.
- Prematurity is a known risk factor for developing inguinal hernias.
- The relationship between congenital abdominal wall defects and IH risk requires further investigation.
Purpose of the Study:
- To assess the incidence of inguinal hernia (IH) in infants with congenital abdominal wall defects.
- To compare IH risk between infants with gastroschisis and omphalocele versus healthy controls.
- To investigate potential etiological factors, such as intra-abdominal pressure, for IH in this population.
Main Methods:
- Nationwide population-based case-control study utilizing Finnish registers (Congenital Malformations, Medical Birth, Hospital Discharge).
- Inclusion of infants born with gastroschisis or omphalocele between 1998-2014.
- Selection of six matched healthy controls for each case, matched by gestational age, sex, and birth year.
Main Results:
- Significantly higher IH incidence in gastroschisis girls (RR 7.20) compared to controls.
- Omphalocele was associated with a substantially increased IH risk in both males and females (RR 6.46).
- No statistically significant IH risk increase was observed in boys with gastroschisis (RR 1.60).
Conclusions:
- Congenital abdominal wall defects are associated with a significantly elevated risk of inguinal hernia.
- Findings support the hypothesis that increased intra-abdominal pressure may impede the natural closure of the processus vaginalis.
- Informing families about this elevated risk and ensuring early clinical follow-up are crucial for timely diagnosis and management.
Abstract:
The aim of this nationwide population-based case-control study was to assess the incidence of inguinal hernia (IH) among patients with congenital abdominal wall defects. All infants born with congenital abdominal wall defects between Jan 1, 1998, and Dec 31, 2014, were identified in the Finnish Register of Congenital Malformations. Six controls matched for gestational age, sex, and year of birth were selected for each case in the Medical Birth Register. The Finnish Hospital Discharge Register was searched for relevant diagnosis codes for IH, and hernia incidence was compared between cases and controls. We identified 178 infants with gastroschisis and 150 with omphalocele and selected randomly 1968 matched, healthy controls for comparison. Incidence of IH was significantly higher in gastroschisis girls than in matched controls, relative risk (RR) 7.20 (95% confidence interval [CI] 2.25-23.07). In boys with gastroschisis, no statistically significant difference was observed, RR 1.60 (95% CI 0.75-3.38). Omphalocele was associated with higher risk of IH compared to matched controls, RR 6.46 (95% CI 3.90-10.71), and the risk was equally elevated in male and female patients.Conclusion: Risk of IH is significantly higher among patients with congenital abdominal wall defects than in healthy controls supporting hypothesis that elevated intra-abdominal pressure could prevent natural closure of processus vaginalis. Parents should be informed of this elevated hernia risk to avoid delays in seeking care. We also recommend careful follow-up during the first months of life as most of these hernias are diagnosed early in life. What is Known: • Inguinal hernia is one of the most common disorders encountered by a pediatric surgeon. • Prematurity increases the risk of inguinal hernia. What is New: • Children with congenital abdominal wall defects have a significantly higher risk of inguinal hernia than general population. • Families should be informed of this elevated hernia risk to avoid delays in seeking care.
