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Early Versus Late Inguinal Hernia Repair in Preterm Neonates: An Updated Systematic Review and Meta-Analysis with
Muhammad Osama Khan1, Asad Saulat Fatimi2, Humza Thobani3
1Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
Journal of Pediatric Surgery
|July 14, 2025
Summary
Delayed inguinal hernia repair in preterm infants may reduce recurrence and respiratory issues. This approach appears safer than early repair, though more research is needed for optimal timing guidelines.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Evidence-Based Medicine
Background:
- The optimal timing for inguinal hernia repair in preterm neonates is debated.
- Early repair reduces incarceration risk but increases perioperative complications.
- Delayed repair lowers anesthetic risk but increases incarceration risk while awaiting surgery.
Purpose of the Study:
- To compare early (during birth hospitalization) versus delayed (post-discharge) inguinal hernia repair in preterm neonates.
- To analyze risks and benefits associated with each repair timing strategy.
Main Methods:
- Systematic search of PubMed, Embase, Scopus, Web of Science, and CENTRAL databases.
- Inclusion of all original studies on early versus delayed inguinal hernia repair in preterm neonates.
- Meta-analysis using random-effects models.
Main Results:
- Eleven studies with 5021 preterm infants were analyzed.
- Early repair showed significantly higher risks of hernia recurrence, apnea, prolonged intubation, metachronous hernia, and longer hospital stays.
- No significant differences were observed in testicular atrophy, adjacent structure injury, or operative time.
Conclusions:
- Delayed hernia repair in preterm neonates may be linked to reduced recurrence and respiratory complications.
- This approach may avoid significant increases in incarceration risk while awaiting repair.
- High-quality prospective studies are required to establish optimal timing guidelines.
