Advertisement

Hernia

pp 1–10 | Cite as

Risk of incarceration in children with inguinal hernia: a systematic review

  • C. S. OlesenEmail author
  • L. Q. Mortensen
  • S. Öberg
  • J. Rosenberg
Review
  • 17 Downloads

Abstract

Background

Surgical repair is recommended for all children with inguinal hernia due to fear of incarceration. The aim of this study was to assess the risk of incarceration and strangulation of inguinal hernias in children treated with delayed surgery or no surgery.

Methods

Systematic searches were conducted in three databases. We included studies reporting on children with inguinal hernia, with the majority ≤ 10 years old. The interventions were non-acute inguinal hernia surgery or no surgery. The main outcomes were incarceration and strangulation. Secondary outcomes were postoperative complications. Randomized controlled trials, non-randomized controlled trials, and observational studies were included.

Results

We included 22 studies with 14,959 children. All studies reported on elective repairs. None of the studies specifically reported on watchful waiting. Of the studies reporting wait time as mean or median, the median wait time was 46 days (range 1–552). The crude incarceration rate across the included studies was 7% for all children and 11% for preterm children. The testicular atrophy rate was 1% and the recurrence rate was 1%.

Conclusions

The risk of incarceration in children awaiting inguinal hernia surgery is substantial. In general, we cannot support delaying surgery unnecessarily. However, there may be benefits of delaying surgery in individual cases. In such cases, the surgeon should assess if the benefits may overrule the risk of incarceration.

Keywords

Inguinal hernia Children Elective surgery Delayed repair Incarceration Watchful waiting 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study received no financial support from extramural sources.

Compliance with ethical standards

Conflict of interest

Olesen reports no potential conflicts of interest. Mortensen reports no potential conflicts of interest. Öberg reports no potential conflicts of interest. Rosenberg reports personal fees from Bard and Merck, outside the submitted work.

Ethical standards

This kind of study does not need ethical approval.

Human and animal rights

This article does not contain any studies directly involving human participants, as it is a review of data already collected in a hernia database.

Informed consent

For this type of study informed consent was not required.

References

  1. 1.
    Somme S, Bronsert M, Morrato E, Ziegler M (2013) Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 132:1466–1472.  https://doi.org/10.1542/peds.2013-1243 CrossRefGoogle Scholar
  2. 2.
    Chang S, Chen J, Hsu C, Chuang F, Yang S (2016) The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study. Hernia 20:559–563.  https://doi.org/10.1007/s10029-015-1450-x CrossRefGoogle Scholar
  3. 3.
    Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J (2013) Nationwide prevalence of groin hernia repair. PLoS One 8:e54367.  https://doi.org/10.1371/journal.pone.0054367 CrossRefGoogle Scholar
  4. 4.
    International Pediatric Endosurgery Group (2010) IPEG guidelines for inguinal hernia and hydrocele. J Laparoendosc Adv Surg Tech 20:10–14.  https://doi.org/10.1089/lap.2010.9998 Google Scholar
  5. 5.
    Ein SH, Njere I, Ein A (2006) Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 41:980–986.  https://doi.org/10.1016/j.jpedsurg.2006.01.020 CrossRefGoogle Scholar
  6. 6.
    Bronsther B, Abrams MW, Elboim C (1972) Inguinal hernias in children—a study of 1,000 cases and a review of the literature. J Am Med Womens Assoc 27:522–525Google Scholar
  7. 7.
    Watson DS, Sharp KW, Vasquez JM, Richards WO (1994) Incidence of inguinal hernias diagnosed during laparoscopy. South Med J 87:23–25CrossRefGoogle Scholar
  8. 8.
    Weaver KL, Poola AS, Gould JL, Sharp SW, St. Peter SD, Holcomb GW (2017) The risk of developing a symptomatic inguinal hernia in children with an asymptomatic patent processus vaginalis. J Pediatr Surg 52:60–64.  https://doi.org/10.1016/j.jpedsurg.2016.10.018 CrossRefGoogle Scholar
  9. 9.
    Centeno-Wolf N, Mircea L, Sanchez O, Genin B, Lironi A, Chardot C, Birraux J, Wildhaber BE (2015) Long-term outcome of children with patent processus vaginalis incidentally diagnosed by laparoscopy. J Pediatr Surg 50:1898–1902.  https://doi.org/10.1016/j.jpedsurg.2015.07.001 CrossRefGoogle Scholar
  10. 10.
    Öberg S, Andresen K, Rosenberg J (2017) Etiology of inguinal hernias: a comprehensive review. Front Surg 4:52.  https://doi.org/10.3389/fsurg.2017.00052 CrossRefGoogle Scholar
  11. 11.
    Skandalakis J, Colborn G, Androulakis J, Skandalakis L, Pemberton L (1993) Embryologic and anatomic basis of inguinal herniorrhaphy. Surg Clin N Am 73:799–836CrossRefGoogle Scholar
  12. 12.
    Fitzgibbons RJ, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M, Neumayer LA, Barkun JST, Hoehn JL, Murphy JT, Sarosi GA, Syme WC, Thompson JS, Wang J, Jonasson O (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 295:285–292.  https://doi.org/10.1001/jama.295.3.285 CrossRefGoogle Scholar
  13. 13.
    The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165.  https://doi.org/10.1007/s10029-017-1668-x CrossRefGoogle Scholar
  14. 14.
    Gong W, Li J (2018) Operation versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias: the meta-analysis results of randomized controlled trials. Int J Surg 52:120–125.  https://doi.org/10.1016/j.ijsu.2018.02.030 CrossRefGoogle Scholar
  15. 15.
    Rosenberg J (2008) Pediatric inguinal hernia repair—a critical appraisal. Hernia 12:113–115.  https://doi.org/10.1007/s10029-007-0316-2 CrossRefGoogle Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341.  https://doi.org/10.1016/j.ijsu.2010.02.007 CrossRefGoogle Scholar
  17. 17.
    Higgins J, Green S (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Cochrane Collab. http://handbook.cochrane.org/. Accessed 3 May 2018
  18. 18.
    Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2013) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 3 May 2018
  19. 19.
    Skoog S, Conlin M (1995) Pediatric hernias and hydroceles. The urologist’s perspective. Urol Clin N Am 22:119–130Google Scholar
  20. 20.
    Hirabayashi T, Ueno S, Hirakawa H, Tei E, Mori M (2017) Surgical treatment of inguinal hernia with prolapsed ovary in young girls: emergency surgery or elective surgery. Tokai J Exp Clin Med 42:89–95Google Scholar
  21. 21.
    Ellison JS, Shnorhavorian M, Merguerian PA, Grady R (2016) Impact of concomitant hernia repair at the time of complete primary repair of bladder exstrophy. J Pediatr Urol 12:211.e1–211.e5.  https://doi.org/10.1016/j.jpurol.2016.04.028 CrossRefGoogle Scholar
  22. 22.
    Crankson S, Al Tawil K, Al Namshan M, Baylon B, Gieballa M, Al Jadaan S, Ahmed I (2015) Management of inguinal hernia in premature infants: 10-year experience. J Indian Assoc Pediatr Surg 20:21–24.  https://doi.org/10.4103/0971-9261.145440 CrossRefGoogle Scholar
  23. 23.
    Chan IHY, Lau CT, Chung PHY, Chan KL, Lan LCL, Wong KKY, Tam PKH (2013) Laparoscopic inguinal hernia repair in premature neonates: is it safe? Pediatr Surg Int 29:327–330.  https://doi.org/10.1007/s00383-012-3240-1 CrossRefGoogle Scholar
  24. 24.
    Old O, Rogers T (2012) Restructuring services to reduce waiting times and prevent complications: neonatal inguinal hernias at Bristol Children’s Hospital. Clin Gov 17:39–44.  https://doi.org/10.1108/14777271211200738 CrossRefGoogle Scholar
  25. 25.
    Nah SA, Giacomello L, Eaton S, de Coppi P, Curry JI, Drake DP, Kiely EM, Pierro A (2011) Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open? Eur J Pediatr Surg 21:8–11.  https://doi.org/10.1055/s-0030-1262793 CrossRefGoogle Scholar
  26. 26.
    Chen LE, Zamakhshary M, Foglia RP, Coplen DE, Langer JC (2009) Impact of wait time on outcome for inguinal hernia repair in infants. Pediatr Surg Int 25:223–227.  https://doi.org/10.1007/s00383-008-2306-6 CrossRefGoogle Scholar
  27. 27.
    Koivusalo A, Pakarinen MP, Rintala RJ (2007) Laparoscopic herniorrhaphy after manual reduction of incarcerated inguinal hernia. Surg Endosc 21:2147–2149.  https://doi.org/10.1007/s00464-007-9318-5 CrossRefGoogle Scholar
  28. 28.
    Gahukamble DB, Khamage AS (1996) Early versus delayed repair of reduced incarcerated inguinal hernias in the pediatric population. J Pediatr Surg 31:1218–1220CrossRefGoogle Scholar
  29. 29.
    Gyrtrup HJ, Mejdahl S, Kvist E, Skeie E (1990) Emergency presentation of inguinal hernia in childhood—treatment strategy. A follow-up study. Ann Chir Gynaecol 79:97–100Google Scholar
  30. 30.
    Puri P, Guiney EJ, O’Donnell B (1984) Inguinal hernia in infants: the fate of the testis following incarceration. J Pediatr Surg 19:44–46CrossRefGoogle Scholar
  31. 31.
    Sulkowski JP, Cooper JN, Duggan EM, Balci O, Anandalwar SP, Blakely ML, Heiss K, Rangel S, Minneci PC, Deans KJ (2015) Does timing of neonatal inguinal hernia repair affect outcomes? J Pediatr Surg 50:171–176.  https://doi.org/10.1016/j.jpedsurg.2014.10.035 CrossRefGoogle Scholar
  32. 32.
    Takahashi A, Toki F, Yamamoto H, Otake S, Oki Y, Kuwano H (2012) Outcomes of herniotomy in premature infants: recent 10 year experience. Pediatr Int 54:491–495.  https://doi.org/10.1111/j.1442-200X.2012.03607.x CrossRefGoogle Scholar
  33. 33.
    Vaos G, Gardikis S, Kambouri K, Sigalas I, Kourakis G, Petoussis G (2010) Optimal timing for repair of an inguinal hernia in premature infants. Pediatr Surg Int 26:379–385.  https://doi.org/10.1007/s00383-010-2573-x CrossRefGoogle Scholar
  34. 34.
    González Santacruz M, Mira Navarro J, Encinas Goenechea A, García Ceballos A, Sánchez Zaplana H, Jiménez Cobo B (2004) Low prevalence of complications of delayed herniotomy in the extremely premature infant. Acta Paediatr 93:94–98CrossRefGoogle Scholar
  35. 35.
    Uemura S, Woodward AA, Amerena R, Drew J (1999) Early repair of inguinal hernia in premature babies. Pediatr Surg Int 15:36–39.  https://doi.org/10.1007/s003830050507 CrossRefGoogle Scholar
  36. 36.
    Chang S-J, Chen JY-C, Hsu C-K, Chuang F-C, Yang SS-D (2016) The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study. Hernia 20:559–563.  https://doi.org/10.1007/s10029-015-1450-x CrossRefGoogle Scholar
  37. 37.
    Kurobe M, Baba Y, Otsuka M (2016) Inguinal hernia in very low-birthweight infants: follow up to adolescence. Pediatr Int 58:1322–1327.  https://doi.org/10.1111/ped.13060 CrossRefGoogle Scholar
  38. 38.
    de Goede B, Verhelst J, van Kempen BJ, Baartmans MG, Langeveld HR, Halm JA, Kazemier G, Lange JF, Wijnen RMH (2015) Very low birth weight is an independent risk factor for emergency surgery in premature infants with inguinal hernia. J Am Coll Surg 220:347–352.  https://doi.org/10.1016/j.jamcollsurg.2014.11.023 CrossRefGoogle Scholar
  39. 39.
    Lautz TB, Raval MV, Reynolds M (2011) Does timing matter? A national perspective on the risk of incarceration in premature neonates with inguinal hernia. J Pediatr 158:573–577.  https://doi.org/10.1016/j.jpeds.2010.09.047 CrossRefGoogle Scholar
  40. 40.
    Lee SL, Gleason JM, Sydorak RM (2011) A critical review of premature infants with inguinal hernias: optimal timing of repair, incarceration risk, and postoperative apnea. J Pediatr Surg 46:217–220.  https://doi.org/10.1016/j.jpedsurg.2010.09.094 CrossRefGoogle Scholar
  41. 41.
    Seo S, Takahashi T, Marusasa T, Kusafuka J, Koga H, Halibieke A, Lane GJ, Okazaki T, Yamataka A (2012) Management of inguinal hernia in children can be enhanced by closer follow-up by consultant pediatric surgeons. Pediatr Surg Int 28:33–36.  https://doi.org/10.1007/s00383-011-3005-2 CrossRefGoogle Scholar
  42. 42.
    Gholoum S, Baird R, Laberge J-M, Puligandla PS (2010) Incarceration rates in pediatric inguinal hernia: do not trust the coding. J Pediatr Surg 45:1007–1011.  https://doi.org/10.1016/j.jpedsurg.2010.02.033 CrossRefGoogle Scholar
  43. 43.
    Turial S, Enders J, Krause K (2010) Laparoscopic inguinal herniorrhaphy in premature infants. Eur J Pediatr Surg 20:371–374.  https://doi.org/10.1055/s-0030-1261932 CrossRefGoogle Scholar
  44. 44.
    Zamakhshary M, To T, Guan J, Langer JC (2008) Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery. CMAJ 179:1001–1005.  https://doi.org/10.1503/cmaj.070923 CrossRefGoogle Scholar
  45. 45.
    Koivusalo AI, Korpela R, Wirtavuori K, Piiparinen S, Rintala RJ, Pakarinen MP (2009) A single-blinded, randomized comparison of laparoscopic versus open hernia repair in children. Pediatrics 123:332–337.  https://doi.org/10.1542/peds.2007-3752 CrossRefGoogle Scholar
  46. 46.
    Niedzielski J, Król R, Gawłowska A (2003) Could incarceration of inguinal hernia in children be prevented? Med Sci Monit 9:16–18Google Scholar
  47. 47.
    Stephens BJ, Rice WT, Koucky CJ, Gruenberg JC (1992) Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical considerations for improved outcome. World J Surg 16:952–957CrossRefGoogle Scholar
  48. 48.
    Stylianos S, Jacir NN, Harris BH (1993) Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg 28:582–583CrossRefGoogle Scholar
  49. 49.
    Habre W, Disma N, Virag K, Becke K, Hansen TG, Johr M, Leva B, Morton NS, Vermeulen PM, Zielinska M, Boda K, Veyckemans F (2017) Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med 5:412–425.  https://doi.org/10.1016/S2213-2600(17)30116-9 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Center for Perioperative Optimization, Herlev HospitalUniversity of CopenhagenHerlevDenmark

Personalised recommendations