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Inguinal hernias in children: Update on management guidelines
Mariana Morgado1, Andrew Ja Holland1,2,3
1Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Insights
This review examines guidelines for pediatric inguinal hernia repair. Key findings suggest delaying repair in premature infants and considering regional anesthesia to reduce complications.
Area of Science:
- Pediatric Surgery
- Surgical Guidelines
- Hernia Management
Background:
- Inguinal hernia repair is a common pediatric procedure with ongoing controversies in management.
- Recent guidelines from major pediatric surgical associations offer updated recommendations.
Purpose of the Study:
- To critically appraise recent guidelines on pediatric inguinal hernia management.
- To identify and review literature on controversial aspects of care.
Main Methods:
- Critical appraisal of guidelines from the American Academy of Pediatrics (2023) and European Pediatric Surgeons' Association (2022).
- Review of recent scientific literature pertaining to pediatric inguinal hernias.
Main Results:
- Evidence suggests postponing hernia repair in preterm infants until after discharge to minimize respiratory issues and recurrence.
- Laparoscopic repair offers comparable outcomes to open surgery, potentially reducing operative time for bilateral hernias.
- Contralateral exploration lacks clear recommendation and requires case-by-case evaluation.
- Regional anesthesia in preterm infants may decrease post-operative apnea and pain without affecting neurodevelopment.
Conclusions:
- Management of pediatric inguinal hernias involves nuanced decisions regarding timing, surgical approach, and contralateral exploration.
- Evidence supports specific recommendations for preterm infants, including delayed repair and regional anesthesia considerations.
Abstract:
Inguinal hernia repair is one of the most performed procedures in children, but aspects of care remain controversial. The aim of this review was to provide a critical appraisal of recently published guidelines on the management of inguinal hernias in children, by the American Academy of Pediatrics (2023) and the European Pediatric Surgeons' Association Evidence and Guideline Committee (2022). This was achieved by delineating areas of controversy and reviewing the most relevant recent literature on these topics. Currently available moderate-to-low quality evidence recommends postponing hernia repair in premature infants until after discharge, to reduce the risk of respiratory difficulties and recurrence. Laparoscopic repair provides similar outcomes to open but may shorten operative time in bilateral cases. No clear recommendation can be made for contralateral exploration, therefore should be evaluated case by case. In preterm infants, consideration of regional anaesthesia may reduce post-operative apnoea and pain, with no difference in neurodevelopment outcomes.
