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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.
Insights
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.
Background:
The optimal timing of inguinal hernia repair in preterm neonates remains debated. Early repair may reduce incarceration risk but increases perioperative complications, while delayed repair lowers anesthetic risk but raises the risk of incarceration while awaiting repair. In the absence of consensus guidelines, practices vary widely. This systematic review and meta-analysis aimed to compare early (during birth hospitalization) versus delayed (post-discharge) inguinal hernia repair in preterm neonates.
Methods:
PubMed, Embase, Scopus, Web of Science, and CENTRAL were systematically searched from inception to May 2025. All original studies reporting data on early and delayed repair of inguinal hernia in preterm neonates were included. Meta-analyses were performed using random-effects models on RevMan version 5.4.1.
Results:
Eleven studies involving 5021 preterm infants were included, comprising one RCT and ten retrospective cohort studies. Early repair was associated with statistically significantly increased risks of hernia recurrence (RR: 2.52 [95 % CI: 1.16, 5.48], apnea requiring intervention (RR: 3.08 [95 % CI: 1.71, 5.55]), prolonged intubation (>48 h; RR: 4.97 [95 % CI: 2.40, 10.27]), metachronous hernia (RR: 6.32 [95 % CI: 2.44, 16.42]), and prolonged hospital stay (MD: 10.40 days [95 % CI: 1.63, 19.17]). No statistically significant differences were found in the risk of testicular atrophy, injury to adjacent structures, or operative time.
Conclusions:
Delayed hernia repair in preterm neonates may be associated with lower risks of recurrence and respiratory complications without a significant increase in risk of incarceration while awaiting repair. Further high-quality prospective studies are needed to optimize timing guidelines.
