The Impact of Surgical Repair on Restlessness in Infants with Non-Incarcerated Inguinal Hernias: A Prospective Study

Background/Objectives: Pediatric inguinal hernias are usually described as asymptomatic unless they become incarcerated. Our aim was to evaluate possible restlessness associated with non-incarcerated inguinal hernias in infants. Methods: We performed a prospective multi-center cohort study that included infants, up to 18 months of age, with non-incarcerated inguinal hernias. Restlessness was evaluated by caregivers before ("Pre") and after ("Post") hernia repair using two scales, the soothability section of the Infant Behavioral Questionnaire (IBQ) and the Parents' Restlessness Score (PRS) on a 1-5 scale (5-highest degree of restlessness), and then compared to matched healthy controls. The change in restlessness after surgery was evaluated by Parents' Change in restlessness Score (PCS) and the difference between Pre- and Post-scores (Δ). A subgroup analysis for patients with Pre-PRS ≥ 3 was performed. Demographic and clinical characteristics were collected, and possible associations with levels of restlessness were evaluated. Results: Seventy-nine infants, median corrected age 2.5 (1.6-4.8) months, were included in this study during June 2022 to July 2024. Infants with inguinal hernias were found to suffer significant restlessness as compared to controls [Pre-PRS = 3 (2-4) vs. 2 (2-2), respectively, p < 0.001]. After hernia repair, PRS restlessness scores improved [ΔPRS = 1 (0-2)] to the level of controls (Post-PRS = 2 (1-3), p = 0.5). The difference in IBQ scores between hernia patients prior to repair and control patients was not statistically significant [3.2 (2.3-4.1) vs. 3.1 (2.3-4.1), respectively, p = 0.28], although both Post-PRS and Post-IBQ scores significantly improved as compared to Pre-PRS and Pre-IBQ scores [2 (1-3) and 2.8 (1.7-3.6) vs. 3 (2-4) and 3.2 (2.3-41), p < 0.001 and p = 0.005, respectively]. Fifty-two patients (66%) had Pre-PRS ≥ 3 and demonstrated a more pronounced improvement in restlessness following surgery [ΔPRS = 1.5 (1-2)]. Patients who had Emergency Department visits prior to hernia repair demonstrated both increased baseline restlessness and more pronounced improvement following repair as compared to patients with no visits (Pre-PRS = 3 (3-4) vs. 3 (2-3), p = 0.03; ΔPRS = 1.5 (1-2) vs. 0 (0-1), p < 0.01; ΔIBQ = 0.7 (0.02-1.45) vs. 0.12 (-0.5-1), p = 0.03). Conclusions: Non-incarcerated inguinal hernias in infants are associated with significant restlessness in most cases. Restlessness resolved after surgical repair.