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Inguinal hernia repair in the perinatal period and early infancy: clinical considerations
Insights
Surgical repair of inguinal hernias in hospitalized infants, including premature and those with concurrent illnesses, shows a high rate of recurrence and complications. Early intervention is crucial, but careful consideration of timing and patient condition is necessary for optimal outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes
Background:
- Neonatal intensive care advances increase survival of critically ill infants requiring surgical intervention.
- Symptomatic inguinal hernias are common in preterm and hospitalized neonates.
- Controversy exists regarding optimal timing and safety of early inguinal hernia repair in this population.
Purpose of the Study:
- To evaluate predisposing factors, clinical presentation, and postoperative complications of inguinal hernia repair in hospitalized infants under two months of age.
- To assess outcomes in premature infants and those with concurrent medical conditions.
- To analyze the incidence of recurrence and associated morbidities.
Main Methods:
- Retrospective review of 100 consecutive inguinal hernia repairs in infants less than two months old.
- Analysis of patient demographics, gestational age, comorbidities (RDS, hydrocephalus with VP shunt, CHD), hernia presentation, and surgical approach.
- Evaluation of postoperative complications, readmissions, and need for re-operation.
Main Results:
- 30% of infants were premature; 42% had significant comorbidities.
- Incarceration occurred in 31% of cases, with 9% presenting with intestinal obstruction.
- Readmission for symptomatic hernia occurred in 49% of preterm/ill infants; 8% experienced postoperative complications, including gonadal infarction in two cases.
Conclusions:
- Hospitalized neonates, particularly premature infants, have a high incidence of symptomatic inguinal hernias requiring surgical repair.
- While early repair is often necessary, a significant rate of recurrence and complications necessitates careful management and follow-up.
- Consideration of comorbidities and potential for bilateral involvement is critical for successful surgical outcomes in this vulnerable population.
Abstract:
Contemporary neonatal intensive care has resulted in survival of many seriously ill preterm and older infants that frequently present with symptomatic inguinal hernia. Controversy exists concerning timing and safety of early repair in prematures or other neonates, especially those hospitalized with concurrent illness. This study examines this topic by evaluating predisposing factors, presentation, and postoperative complications in 100 recent consecutive hernia repairs in previously hospitalized infants less than 2 months of age. There were 85 boys and 15 girls. Thirty percent were premature (less than 36 wks gestation). Forty-two infants were hospitalized for RDS with assisted ventilation in 16 infants, hydrocephalus and ventriculoperitoneal (VP) shunt in 7 infants, and congenital heart disease (CHD) in 19 infants. Clinical presentation was on the right side in 44 infants, bilateral in 42, and on the left side in 14. Incarceration occurred in 31 cases with nine babies having overt intestinal obstruction. The incidence of cryptorchidism was 12.9%. All (VP) shunt, CHD patients, and incarcerated cases were treated with preoperative antibiotics. Following discharge, 49 preterm or previously ill infants developed a symptomatic hernia at home and were readmitted. Nine full-term infants were treated as outpatients. Bilateral inguinal exploration was performed in 92 cases with second hernia or patent processus found in 81. Seven of eight with unilateral exploration had acute incarceration with obstruction at the time of the procedure. Three subsequently required a second hernia repair. Two infants with incarceration and cryptorchid testis or ovarian slider had gonadal infarction. There were eight postoperative complications.(ABSTRACT TRUNCATED AT 250 WORDS)