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Delayed versus early repair of inguinal hernia in preterm infants: A systematic review and meta-analysis
Candy Sc Choo1, Yong Chen2, Merrill McHoney3
1University of Edinburgh, Edinburgh, United Kingdom; Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore.
Insights
Early inguinal hernia repair in preterm infants lowers incarceration risk but raises respiratory complication risk. Discussing timing with caregivers is crucial for informed decisions on neonatal inguinal hernia repair.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Clinical outcomes research
Background:
- Inguinal hernias are common in preterm infants.
- The optimal timing for surgical repair (herniotomy) in this population remains debated.
- Early repair may prevent incarceration, while delayed repair might mitigate risks associated with prematurity.
Purpose of the Study:
- To compare clinical outcomes of early versus delayed herniotomy in preterm infants.
- To identify risk factors for complications associated with inguinal hernia repair timing.
- To determine the best timing for surgical intervention in neonatal inguinal hernia.
Main Methods:
- A systematic literature search was conducted on Medline, Embase, and Central databases up to January 25, 2021.
- Included studies compared early (pre-discharge) versus delayed (post-discharge) inguinal hernia repair in preterm infants.
- Meta-analysis using fixed and random effects models was performed.
Main Results:
- Six studies were included in the meta-analysis.
- Early repair significantly reduced the risk of hernia incarceration (OR 0.43).
- Early repair was associated with a higher risk of post-operative respiratory complications (OR 4.36), but recurrence and surgical complication rates did not differ significantly.
Conclusions:
- Early herniotomy in preterm infants decreases incarceration risk but increases post-operative respiratory complications.
- The decision for early versus delayed repair should involve a discussion of risks and benefits between surgeons and caregivers.
- Personalized timing of inguinal hernia repair is recommended based on infant physiology and circumstances.
Objectives:
To evaluate the clinical outcomes of herniotomy in preterm infants undergoing early versus delayed repair, the risk factors for complications, and to identify best timing of surgery.
Methods:
Medline, Embase and Central databases were searched from inception until 25 Jan 2021 to identify publications comparing the timing of neonatal inguinal hernia repair between early intervention (before discharge from first hospitalization) and delayed (after first hospitalisation discharge) intervention. Inclusion criteria was preterm infants diagnosed with inguinal hernia during neonatal intensive care unit admission. Results were analyzed using fixed and random effects meta-analysis (RevManv5.4).
Results:
Out of 721 articles found, six studies were included in the meta-analysis. Patients in the early group had lower odds of developing incarceration [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.34-0.55, I2 = 0%, p < 0.001]; but higher risk of post-operative respiratory complications (OR 4.36, 95% CI 2.13-8.94, I2 = 40%, p < 0.001). No significant differences were reported in recurrence rate (OR 3.10, 95% CI 0.90-10.64, I2 = 0%, p = 0.07) and surgical complication rate (OR 0.94, 95% CI 0.18-4.83, I2 = 0%, p = 0.94) between early and delayed groups.
Conclusion:
While early inguinal hernia repair in preterm infants reduces the risk of incarceration, it increases the risk of post-operative respiratory complications compared to delayed repair. Surgeons should discuss the risks and benefits of delaying inguinal hernia repair with the caregivers to make an informed decision best suited to the patient physiology and circumstances.
Level Of Evidence:
Treatment study, level 3.
