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Immediate Versus Delayed Surgical Management of Infant Cryptorchidism With Inguinal Hernia
Walter A Ramsey1, Carlos T Huerta1, Alexis K Jones2
1DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Insights
Early surgical repair for newborns with undescended testicles (UT) and inguinal hernias (IH) offers no advantage. Delaying surgery until 6-12 months is recommended, as immediate intervention does not improve outcomes and may increase orchiectomy rates.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Urology
Background:
- Cryptorchidism (undescended testicles) is often managed with orchiopexy at 6-12 months.
- Concurrent inguinal hernias (IH) sometimes prompt immediate surgical repair (orchiopexy and inguinal hernia repair - IHR).
- The benefit of early surgical intervention for combined IH and UT in newborns is unclear.
Purpose of the Study:
- To evaluate the outcomes of immediate surgical repair versus delayed repair for newborns diagnosed with both undescended testicles (UT) and inguinal hernias (IH).
Main Methods:
- Retrospective comparative study using the Nationwide Readmissions Database (2010-2014).
- Identified newborns with diagnoses of IH and UT, stratified by initial admission management: immediate IHR (Repair) or deferred IHR (Deferral).
- Compared demographics, outcomes, and complications, weighting results for national estimates.
Main Results:
- Analyzed 1306 newborns (64% premature) with IH and UT; 30% underwent immediate IHR.
- Immediate repair was more common in premature infants and those with congenital anomalies.
- No significant difference in readmission rates between Repair and Deferral groups; Repair group had higher orchiectomy rates. Deferral patients had minimal readmissions for complications.
Conclusions:
- Immediate surgical repair for newborns with UT and IH is not associated with improved outcomes.
- Deferring surgery is safe, with minimal readmission rates for incarceration or bowel compromise.
- Early operative intervention offers no benefit; reassessment for surgery at 6-12 months is recommended.
Introduction:
Cryptorchidism is commonly treated with orchiopexy at 6-12 months of age, often allowing time for undescended testicle(s) (UT) to descend spontaneously. However, when an inguinal hernia (IH) is also present, some surgeons perform orchiopexy and inguinal hernia repair (IHR) immediately rather than delaying surgery. We hypothesize that early surgical intervention provides no benefit for newborns with both IH and UT.
Methods:
The Nationwide Readmissions Database was used to identify newborns with diagnoses of both IH and UT from 2010 to 2014. Patients were stratified by management: IHR performed on initial admission (Repair) or not (Deferral). Demographics, outcomes, and complications were compared. Results were weighted for national estimates.
Results:
We analyzed 1306 newborns (64% premature) diagnosed with both IH and UT. IHR was performed at index admission in 30%. Repair was more common in premature babies (43% vs. 8% full-term, p < 0.001) and patients with congenital anomalies (33% vs. 27% without congenital anomaly, p = 0.012). There was no difference in readmission rates. Repair patients had higher rates of orchiectomy than did Deferral. No Deferral patients were readmitted for bowel resection, and <1% were readmitted for orchiectomy or hernia incarceration.
Conclusion:
In newborns with UT and IH, immediate repair is not associated with improved outcomes. Even with incarceration on initial presentation, rates of readmission with incarceration or bowel compromise for patients who undergo Deferral of surgery are minimal. Moreover, Repair newborns have higher rates of orchiectomy. We found no benefit to early operative intervention; thus, we recommend waiting until 6-12 months of age to reassess for surgery.
Level Of Evidence:
Level III TYPE OF STUDY: Retrospective Comparative Study.
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