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Meta-Analysis to Determine Optimal Timing for Repair of Inguinal Hernia in Pre-Term Infants
Tallal Mushtaq Hashmi1, Hadiah Ashraf1, Tehreem Fatima2
1Rawalpindi Medical University, Rawalpindi, Pakistan.
Insights
Early inguinal hernia repair in preterm infants reduces incarceration but increases respiratory complications and recurrence. The optimal timing requires balancing these risks for better clinical outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes Research
Background:
- Conflicting evidence exists on the optimal timing for inguinal hernia repair in preterm infants.
- This review synthesizes current evidence on early versus delayed repair outcomes.
Purpose of the Study:
- To provide updated insights into clinical outcomes of early versus delayed inguinal hernia repair in preterm infants.
- To inform clinical decision-making regarding surgical timing.
Main Methods:
- A meta-analysis of randomized controlled trials and cohort studies was performed.
- Searches included PubMed, Cochrane Library, Clinicaltrials.gov, and Embase up to July 2024.
- Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random effects model.
Main Results:
- 10 studies with 4253 preterm infants were analyzed.
- Early repair significantly reduced incarceration (OR 0.43) but increased respiratory complications (OR 5.17) and recurrence (OR 3.25).
- No significant differences were found for testicular atrophy, ascending testis, hydrocele, or bowel injury.
Conclusions:
- The timing of inguinal hernia repair involves balancing the risk of incarceration against anesthetic and recurrence concerns.
- Early repair lowers incarceration risk but elevates risks of respiratory issues and recurrence.
- Clinical decisions should weigh these competing risks for optimal patient management.
Background:
Studies have shown conflicting findings regarding the optimal time for the repair of inguinal hernia in preterm infants. Our review aims to comprehensively synthesize the available evidence and provide robust, up-to-date insights into the clinical outcomes of delayed versus early repair of inguinal hernia in these patients.
Methods:
A comprehensive search across PubMed, Cochrane Library, Clinicaltrials.gov, and Embase was conducted from inception until July 2024 to include RCTs and cohort studies comparing early versus delayed inguinal hernia repair. The odds ratios (ORs) were pooled along with corresponding 95% confidence intervals (CIs) for all clinical endpoints with the random effects model using RevMan 5.4.
Results:
Our meta-analysis pooled 10 studies involving 4253 preterm infants. The early hernia repair group had lower odds of developing incarceration (OR 0.43, 95% CI 0.34-0.54, p < 0.00001) but increased respiratory complications (OR 5.17, 95% CI 3.97-6.73, p < 0.00001) and recurrence rates (OR 3.25, 95% CI 1.18-8.92, p = 0.02) as compared to the delayed group. There were no statistically significant differences in testicular atrophy (OR 1.13, p = 0.91), iatrogenic ascending testis (OR 1.71, p = 0.61), postoperative hydrocele (OR 3.69, p = 0.21) or bowel injury (OR 1.16, p = 0.88) between early and delayed repair groups.
Conclusion:
Timing of inguinal hernia repair requires balancing the risk of incarceration with anesthetic and recurrence concerns. Early hernia repair reduces incarceration but is associated with higher rates of respiratory complications and recurrence.
