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Meta-analysis of the risk of metachronous hernia in infants and children
D M Miltenburg1, J G Nuchtern, T Jaksic
1Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Insights
Routine contralateral exploration after pediatric inguinal hernia repair is not recommended. Left-sided hernias carry a higher risk of metachronous hernia development, warranting careful consideration for exploration in select cases.
Area of Science:
- Pediatric Surgery
- Clinical Outcomes Research
Background:
- Inguinal herniorrhaphy is a common pediatric surgical procedure.
- Contralateral patent processus vaginalis often prompts exploration, but doesn't always lead to clinical hernia.
Purpose of the Study:
- To evaluate the incidence and risk factors for metachronous inguinal hernias in children after unilateral repair.
- To inform guidelines on contralateral groin exploration.
Main Methods:
- Meta-analysis of published pediatric series on unilateral inguinal hernia repair.
- Assessment of metachronous hernia development and associated risk factors.
Main Results:
- 1,062 of 15,310 (7%) pediatric patients developed metachronous hernias.
- Left-sided hernias had an 11% risk, 50% higher than right-sided hernias.
- 90% of metachronous hernias occurred within 5 years, with a 0.5% complication rate.
Conclusions:
- Routine contralateral groin exploration is not indicated.
- High-risk infants, particularly after left inguinal herniorrhaphy, may benefit from exploration.
- Follow-up for 5 years is recommended for patients not undergoing contralateral exploration.
Background:
Inguinal herniorrhaphy is the most common general surgical procedure performed in children. The presence of a contralateral patent processus vaginalis forms the basis of the recommendation for contralateral exploration in patients undergoing unilateral herniorrhaphy. However, a patent processus vaginalis does not necessarily go on to become a clinically apparent inguinal hernia.
Methods:
All published pediatric series, in which patients underwent unilateral inguinal hernia repair and were evaluated for the development of a metachronous hernia, were included. The incidence of and risk factors associated with development a metachronous hernia were evaluated with meta-analysis.
Results:
There were 15,310 patients ranging in age from birth to 16 years, including premature infants. Of these, 1,062 patients (7%) developed a metachronous hernia. Gender and age were not risk factors. There was an 11% risk of metachronous hernia if the original hernia was on the left side, a risk that was 50% greater than if the original hernia was on the right. Of patients who developed a metachronous hernia, 90% did so within 5 years. The complication rate of metachronous hernia was 0.5%.
Conclusion:
There is no role for routine contralateral groin exploration. High-risk infants and children, especially those who undergo left inguinal herniorrhaphy, may benefit from contralateral groin exploration. If a patent processus vaginalis is found, it should be ligated. Patients who do not undergo contralateral groin exploration should be followed up for 5 years.
