Impact of Delayed Inguinal Hernia Repair in Infants

Inguinal hernia repair is one of the most common pediatric surgical procedures performed with an estimated incidence of 1-5% in children. Patients can present with or without symptoms, with symptomatic hernias (incarcerated or strangulated) that may require emergent or urgent operative intervention. During the COVID-19 pandemic, restrictions, and shutdowns of elective surgeries at our institution resulted in delaying elective inguinal hernia repair unless presenting with more emergent symptoms, with no apparent increase in complication. In our institution, this practice was continued even after COVID restrictions were lifted, with elective repairs delayed until patients were older before completing elective inguinal hernia repair to also reduce early exposure to anesthesia. The aim of this study was to observe any changes in preoperative or postoperative complications after delaying repair of inguinal hernias in infants that initially present to the outpatient clinic.

We completed a retrospective cohort study reviewing children <1 y old who underwent inguinal hernia repairs from January 2018 to January 2024 treated at a single freestanding children's hospital. Patients admitted to the neonatal intensive care unit during surgical management or whose index presentation was in the emergency department (ED) were excluded. Procedures prior to March 1, 2020, were considered pre-COVID while subsequent operations were categorized as post-COVID. In the latter group, surgical repair was delayed until approximately 6 mo of age. Details of their hospitalization, including demographic, operative, and length of stay data, as well as postoperative complications including return to ED, readmission, and recurrence of hernia(s) were collected.

A total of 179 patients were included, and majority were male (85%, n = 153). One-third of patients underwent surgical repair prior to COVID restrictions (32%, n = 58) while 68% of patients (n = 121) were repaired during or after COVID restrictions. The average time from diagnosis of hernia(s) to surgery in the pre-COVID group was 44 d compared to 74 d in the post-COVID group (P = 0.0001). The average age of patients at time of surgery was 125 d in the pre-COVID group compared to 152 d in the post-COVID group (P = 0.034). There was no increase in the rate of patient presentation to the ED/hernia incarceration rate in the post-COVID group (10% pre- versus 8% post-COVID). There were no observed differences in operative characteristics or postoperative complications between groups.

Delayed inguinal hernia repair beyond 4 wks from diagnosis in infants was not associated with any increased risk of hernia incarceration or complications in these patients. Potential benefits of delaying surgery include allowing patients to grow while also avoiding early anesthetic exposure in infancy.