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Implementing Contralateral Surgical Exploration during Hernia Repair in Children with Unilateral Inguinal Hernia: A
Kelly M A Dreuning1, Femke Van Nassau2, Johannes R Anema2
1Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute and the Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Insights
Preventing metachronous contralateral inguinal hernias (MCIH) in infants involves exploring the other side during initial surgery. This study identifies barriers and facilitators to adopting this preventative surgical approach in pediatric patients.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Implementation Science
Background:
- 10-15% of children undergoing unilateral inguinal hernia repair develop metachronous contralateral inguinal hernias (MCIH).
- MCIH necessitates a second anesthesia and surgery, increasing healthcare burden.
- Contralateral exploration during the initial surgery is a potential preventative strategy.
Purpose of the Study:
- To investigate factors promoting or hindering the adoption and implementation of contralateral groin exploration in infants undergoing unilateral hernia repair.
- To identify strategies for overcoming barriers to implementing this surgical approach.
- To inform decision-making regarding contralateral exploration based on potential patient and family outcomes.
Main Methods:
- Qualitative interview study design.
- Conducted 14 semi-structured interviews and two focus groups.
- Involved pediatric surgeons, healthcare professionals, patient family stakeholders, and organizational/policy stakeholders.
Main Results:
- Barriers to implementation included perceptions of surgical treatment effectiveness and stakeholder attitudes.
- Facilitating factors for future implementation involved focusing on patient and family outcomes and experiences.
- Strategies to overcome barriers were identified, though not detailed in the abstract.
Conclusions:
- Understanding facilitators and barriers is crucial for implementing contralateral groin exploration.
- Study findings can aid decision-making if future trials demonstrate benefits for specific patient groups.
- This research offers unique insights into the (de-)implementation of a preventative surgical strategy in pediatric inguinal hernia repair.
Abstract:
A total of 10-15% of children undergoing unilateral inguinal hernia repair develop a metachronous contralateral inguinal hernia (MCIH) that necessitates second anesthesia and surgery. Contralateral exploration can be performed to prevent MCIH development. This study investigates (1) factors that promote or hinder the adoption and (de-)implementation of contralateral groin exploration in children ≤ 6 months undergoing unilateral hernia repair and (2) strategies to overcome these barriers. A qualitative interview study was conducted using 14 semi-structured interviews and two focus groups involving healthcare professionals, stakeholders involved from a patients' perspective and stakeholders at the organizational/policy level. The results show that the effectiveness of surgical treatment and stakeholders' motivation and attitudes towards the intervention were reported as barriers for implementation, whereas patient and family outcomes and experience and strategies to overcome these barriers were identified as facilitating factors for future implementation. This study is unique in its contributions towards insights into facilitators and barriers for (de-)implementation of contralateral groin exploration in children with a unilateral inguinal hernia. In case the HERNIIA trial shows that contralateral exploration is beneficial for specific patient and family outcomes or a subgroup of children, the results of this study can help in the decision-making process as to whether contralateral exploration should be performed or not.
