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Early versus Delayed Inguinal Hernia Repair in Preterm Neonates: An Updated Systematic Review and Meta-Analysis.
Danilo Costa Marques da Silva Vasconcellos1, Maria Fernanda Ferreira Viana1, Nathalia de Carvalho Dias Miranda1
1Department of Medicine, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
Summary
Early inguinal hernia repair in preterm infants increases respiratory issues and recurrence. Delaying surgery after neonatal intensive care unit (NICU) discharge may improve outcomes for these vulnerable neonates.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Critical Care Medicine
Background:
- Inguinal hernias affect up to 30% of preterm neonates in the NICU.
- Surgical timing is debated due to respiratory immaturity and incarceration risks.
- Previous analyses lacked robust, randomized data.
Purpose of the Study:
- To compare outcomes of early versus late inguinal hernia repair in preterm neonates.
- To provide an updated meta-analysis using recent and rigorous evidence.
- To inform surgical timing decisions for this population.
Main Methods:
- Systematic review of PubMed, EMBASE, and Cochrane databases.
- Included studies compared early (during NICU stay) vs. late (after discharge) repair.
- Followed PRISMA guidelines; statistical significance set at p < 0.05.
Main Results:
- 8 studies (1 RCT, 7 cohort) with 1,624 preterm neonates.
- Early repair (54.2%) showed no difference in incarceration risk (OR 1.16; p=0.49).
- Early repair significantly increased respiratory complications (OR 3.73; p<0.0001) and recurrence (OR 3.59; p=0.02).
Conclusions:
- Early inguinal hernia repair in preterm neonates elevates risks of respiratory complications and recurrence.
- Delaying surgery until after NICU discharge, when feasible, may optimize outcomes.
- Late repair minimizes perioperative risks for this vulnerable population.
