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Older Children Undergoing Inguinal Hernia Repair Have Higher Recurrence Rates Than Younger Children and Adults: A
John Sincavage1, Gwyneth A Sullivan1, Annie Fritsch1
1Division of Pediatric Surgery, Rush University Medical Center, Chicago, IL 60622, USA.
Insights
Older children (16-17 years) undergoing inguinal hernia repair face higher recurrence risks, suggesting current high ligation techniques may be unsuitable for this age group. Further research is needed to optimize surgical approaches for adolescent hernia repair.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- Inguinal hernia repair in children typically uses high ligation, while adults receive floor repair.
- Limited data exists on the optimal age for transitioning to floor repair in pediatric patients.
- This study investigates factors influencing inguinal hernia recurrence in children.
Purpose of the Study:
- To evaluate the correlation between age and other factors with inguinal hernia recurrence in children.
- To compare recurrence rates between adolescent children and young adults.
- To generate hypotheses regarding the appropriateness of high ligation in older children.
Main Methods:
- Retrospective cohort study of 15,114 children (6-17 years) and 20,863 adults (18-25 years) undergoing inguinal hernia repair.
- Data analyzed from the PearlDiver Mariner database (2010-2022).
- Kaplan-Meier survival analysis and Cox proportional hazards modeling were employed to assess recurrence risk based on age, sex, and obesity.
Main Results:
- Children aged 16-17 years showed a significantly higher five-year recurrence risk (2.5%) compared to younger children (0.8%) and young adults (1.2%).
- Obese males aged 14-17 years exhibited the highest five-year recurrence rate at 4.7%.
- Adjusted hazard ratios indicated increased recurrence risk for older children compared to both younger pediatric patients and young adults.
Conclusions:
- Adolescent children (16-17 years) repaired by pediatric surgeons have a greater risk of inguinal hernia recurrence.
- The findings suggest that high ligation, a common pediatric technique, might be suboptimal for older children.
- Consideration should be given to alternative repair methods for older pediatric patients to reduce recurrence rates.
Background:
High ligation is the standard practice for inguinal hernia repair in children while adults undergo a floor repair. There is limited data to guide recommendations on the age at which floor repair should be considered. This is a hypothesis-generating study to understand the correlation of age and other factors with inguinal hernia recurrence in children.
Materials And Methods:
Children aged 6-17 years who underwent inguinal hernia repair by a pediatric surgeon between 2010 and 2022 were identified in the PearlDiver Mariner database, as were adults aged 18-25 years treated by an adult surgeon. Kaplan-Meier survival analysis and Cox proportional hazards modeling was used to determine the risk of hernia recurrence by age, sex, and obesity status.
Results:
A total of 15,114 children and 20,863 adults were included. Children aged 16-17 years had a significantly increased five-year risk of hernia recurrence compared to children aged 6-10 years (2.5 % vs 0.8 %, adjusted hazard ratio [AHR]: 3.00, 95 % confidence interval [CI]: 1.98-4.56) as well as compared to the adult group (2.5 % vs 1.2 %, AHR 1.90, 95 % CI: 1.31-2.74). Obese males aged 14-17 years had the highest five-year rate of hernia recurrence of any group at 4.7 %.
Conclusions:
Children 16-17 years of age who underwent inguinal hernia repair with pediatric surgeons have an increased risk of hernia recurrence compared to younger children as well as compared to adults treated by general surgeons. We hypothesize that high ligations, commonly performed by pediatric surgeons, may be inappropriate in some groups of older children.
Type Of Study:
Cohort.
Level Of Evidence:
Level III.
