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Routine inguinal hernia repair in the pediatric population: is office follow-up necessary?
J Koulack1, P Fitzgerald, D A Gillis
1Department of Surgery, Izaak Walton Killam Children's Hospital, Halifax, Nova Scotia, Canada.
Insights
Routine pediatric inguinal hernia repair has few complications. Postoperative visits may be unnecessary, as parental reassurance seems to be the main benefit, suggesting alternative follow-up methods could suffice.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
Background:
- Routine pediatric inguinal hernia repair is associated with a low complication rate.
- The necessity of traditional postoperative follow-up visits is questioned due to minimal identified complications.
Purpose of the Study:
- To evaluate current follow-up practices for pediatric inguinal hernia repair.
- To determine the complication rate associated with this procedure.
- To assess the perceived necessity and utility of postoperative follow-up visits from the parents' perspective.
Main Methods:
- Retrospective review of patients undergoing inguinal hernia repair in 1991.
- Telephone questionnaires administered to parents to gauge satisfaction and perceived necessity of follow-up visits.
- Analysis of complication rates and physician follow-up patterns.
Main Results:
- A low complication rate of 0.7% (one stitch abscess) was observed.
- 90% of parents found the follow-up visit helpful, and 80% deemed it necessary.
- 35% of parents indicated satisfaction with telephone follow-up as an alternative.
Conclusions:
- The primary role of postoperative visits for pediatric inguinal hernia repair appears to be parental reassurance.
- Optimized preoperative and postoperative instructions and reassurance may adequately serve many patients.
- Alternative follow-up strategies, such as telephone consultations, warrant consideration to potentially streamline care.
Abstract:
Routine inguinal hernia repair in the pediatric population has a low complication rate. Very few complications are identified at follow-up, which brings into question the necessity of the traditional postoperative visit. A retrospective review of patients who had undergone a routine inguinal hernia repair in 1991 at our institution was done in order to determine our current follow-up practices and complication rate. To determine the perceived necessity for the follow-up visit, parents were given a short telephone questionnaire. Of 175 eligible patients, questionnaires were completed on 145. Of these 145 patients, 77 were seen in follow-up by the pediatric surgeon only, 43 by the family doctor only, 12 were seen by both, and 13 patients had no physician follow-up. The sole complication was a stitch abscess (complication rate 0.7%). Results of the questionnaire showed that 90% of parents felt the follow-up visit was "helpful," 80% felt it was "necessary," and 35% would have been satisfied with telephone follow-up. The main purpose of the postoperative visit appears to be parental reassurance. Careful preoperative and postoperative instruction and reassurance may be sufficient in a significant number of cases.