Pediatric Surgery International

, Volume 34, Issue 5, pp 553–560 | Cite as

Testicular atrophy following inguinal hernia repair in children

  • Kristin A. Sonderman
  • Lindsey L. Wolf
  • Lindsey B. Armstrong
  • Kathryn Taylor
  • Wei Jiang
  • Brent R. Weil
  • Tracey P. Koehlmoos
  • Robert L. Ricca
  • Christopher B. Weldon
  • Adil H. Haider
  • Samuel E. Rice-Townsend
Original Article



We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children.


We used the TRICARE database, which tracks care delivered to active and retired members of the US Armed Forces and their dependents, including > 3 million children. We abstracted data on male children < 12 years who underwent inguinal hernia repair (2005–2014). We excluded patients with history of testicular atrophy, malignancy or prior related operation. Our primary outcome was the incidence of the diagnosis of testicular atrophy. Among children with atrophy, we calculated median time to diagnosis, stratified by age/undescended testis.


8897 children met inclusion criteria. Median age at hernia repair was 2 years (IQR 1–5). Median follow-up was 3.57 years (IQR 1.69–6.19). Overall incidence of testicular atrophy was 5.1/10,000 person-years, with the highest incidence in those with an undescended testis (13.9/10,000 person-years). All cases occurred in children \(\le\) 5 years, with 72% in children < 2 years. Median time to atrophy was 2.4 years (IQR 0.64–3), with 30% occurring within 1 year and 75% within 3 years.


Testicular atrophy is a rare complication following inguinal hernia repair, with children < 2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later.

Level of evidence

Prognosis Study, Level II.


Testicular atrophy Inguinal hernia complication Pediatrics 



This project was funded in part by the Henry M. Jackson Foundation for the Advancement of Military Medicine through a grant from the Department of Defense (DoD). WJ and AHH receive partial salary support. The funding source did not have a role in the collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

Dr. Adil Haider: Supported by the Henry M. Jackson Foundation HU0001-11-1- 0023 and the comparative effectiveness and provider induced demand collaboration (EPIC): A clinical and economic analysis of variation in healthcare. The Center for Surgery and Public Health and the Uniformed Services University of Health Sciences are jointly supported by the Henry M. Jackson Foundation for the Advancement of Military Medicine to provide protected research efforts involving the analysis and study of military TRICARE data. AHH receives partial salary support. AHH is the Principal Investigator (PI) of the joint study; he also serves on the Institute of Medicine’s Military Trauma Care’s Learning Health System and its Translation to the Civilian Sector Committee. Not related to this work, AHH is the PI of a contract (AD-1306-03980) with the Patient-Centered Outcomes Research Institute entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED” and a Harvard Surgery Affinity Research Collaborative (ARC) Program Grant entitled “Mitigating Disparities Through Enhancing Surgeons’ Ability To Provide Culturally Relevant Care.” Conflict of Interest: Not related to this work, AHH is the co-founder and an equity holder in Patient Doctor Technologies Inc., which owns and operates the website


  1. 1.
    Meier AH, Ricketts RR (2003) Surgical complications of inguinal and abdominal wall hernias. Semin Pediatr Surg 12:83–88CrossRefPubMedGoogle Scholar
  2. 2.
    Grosfeld JL (1989) Current concepts in inguinal hernia in infants and children. World J Surg 13:506–515Google Scholar
  3. 3.
    Katz DA (2001) Evaluation and management of inguinal and umbilical hernias. Pediatr Ann 30:729–735CrossRefPubMedGoogle Scholar
  4. 4.
    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. CrossRefPubMedGoogle Scholar
  5. 5.
    Fette AM, Höllwarth ME (2001) Special aspects of neonatal inguinal hernia and herniotomy. Hernia 5:92–96CrossRefPubMedGoogle Scholar
  6. 6.
    Rajput A, Gauderer MW, Hack M (1992) Inguinal hernias in very low birth weight infants: incidence and timing of repair. J Pediatr Surg 27:1322–1324CrossRefPubMedGoogle Scholar
  7. 7.
    Erdoǧan D, Karaman I, Aslan MK et al (2013) Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary center. J Pediatr Surg 48:1767–1772. CrossRefPubMedGoogle Scholar
  8. 8.
    Skinner MA, Grosfeld JL (1993) Inguinal and umbilical hernia repair in infants and children. Surg Clin North Am 73:439–449CrossRefPubMedGoogle Scholar
  9. 9.
    Puri P, Guiney EJ, O’Donnell B (1984) Inguinal hernia in infants: the fate of the testis following incarceration. J Pediatr Surg 19:44–46CrossRefPubMedGoogle Scholar
  10. 10.
    Glick PL, Boulanger SC (2012) Inguinal hernias and hydroceles. In: Pediatric surgery. Elsevier, Philadelphia, pp 985–1001.
  11. 11.
    Phelps S, Agrawal M (1997) Morbidity after neonatal inguinal herniotomy. J Pediatr Surg 32:445–447CrossRefPubMedGoogle Scholar
  12. 12.
    Miyake H, Fukumoto K, Yamoto M et al (2016) Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases. Surg Endosc 30:1466–1472. CrossRefPubMedGoogle Scholar
  13. 13.
    Ozdamar MY, Karakus OZ (2017) Testicular Ischemia caused by incarcerated inguinal Hernia in infants: incidence, conservative treatment procedure, and follow-up. Urol J 14:4030–4033PubMedGoogle Scholar
  14. 14.
    Niedzielski J, Kr l R, Gawłowska A (2003) Could incarceration of inguinal hernia in children be prevented? Med Sci Monit 9:CR16–8PubMedGoogle Scholar
  15. 15.
    Walc L, Bass J, Rubin S, Walton M (1995) Testicular fate after incarcerated hernia repair and/or orchiopexy performed in patients under 6 months of age. J Pediatr Surg 30:1195–1197CrossRefPubMedGoogle Scholar
  16. 16.
    Wright NJ, Davidson JR, Major C et al (2017) The management of boys under 3 months of age with an inguinal hernia and ipsilateral palpable undescended testis. J Pediatr Surg 52:1108–1112. CrossRefPubMedGoogle Scholar
  17. 17.
    Schoenfeld AJ, Jiang W, Harris MB et al (2016) Association between race and postoperative outcomes in a universally insured population versus patients in the state of California. Ann Surg. Google Scholar
  18. 18.
    Zogg CK, Jiang W, Chaudhary MA et al (2016) Racial disparities in emergency general surgery. J Trauma Acute Care Surg 80:764–777. CrossRefPubMedGoogle Scholar
  19. 19.
    Stewart KA, Higgins PC, McLaughlin CG et al (2010) Differences in prevalence, treatment, and outcomes of asthma among a diverse population of children with equal access to care: findings from a study in the military health system. Arch Pediatr Adolesc Med 164:720–726. CrossRefPubMedGoogle Scholar
  20. 20.
    Gimbel RW, Pangaro L, Barbour G (2010) America’s “undiscovered” laboratory for health services research. Med Care 48:751–756. CrossRefPubMedGoogle Scholar
  21. 21.
    Ng B, Aslam F, Petersen NJ et al (2012) Identification of rheumatoid arthritis patients using an administrative database: a veterans affairs study. Arthritis Care Res (Hoboken) 64:1490–1496. CrossRefGoogle Scholar
  22. 22.
    Rhee D, Salazar JH, Zhang Y et al (2013) A Novel multispecialty surgical risk score for children. Pediatrics 131:e829–e836. CrossRefPubMedGoogle Scholar
  23. 23.
    Orth RC, Towbin AJ (2012) Acute testicular ischemia caused by incarcerated inguinal hernia. Pediatr Radiol 42:196–200. CrossRefPubMedGoogle Scholar
  24. 24.
    Nagraj S, Sinha S, Grant H et al (2006) The incidence of complications following primary inguinal herniotomy in babies weighing 5 kg or less. Pediatr Surg Int 22:500–502. CrossRefPubMedGoogle Scholar
  25. 25.
    Hughes K, Horwood JF, Clements C et al (2016) Complications of inguinal herniotomy are comparable in term and premature infants. Hernia 20:565–569. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kristin A. Sonderman
    • 1
    • 2
  • Lindsey L. Wolf
    • 1
    • 2
  • Lindsey B. Armstrong
    • 3
  • Kathryn Taylor
    • 4
  • Wei Jiang
    • 1
  • Brent R. Weil
    • 3
  • Tracey P. Koehlmoos
    • 5
  • Robert L. Ricca
    • 5
  • Christopher B. Weldon
    • 3
  • Adil H. Haider
    • 1
    • 2
  • Samuel E. Rice-Townsend
    • 3
  1. 1.Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s HospitalHarvard Medical School, and Harvard T.H. Chan School of Public HealthBostonUSA
  2. 2.Division of Trauma, Burns, and Surgical Critical Care, Department of SurgeryBrigham and Women’s HospitalBostonUSA
  3. 3.Department of SurgeryBoston Children’s HospitalBostonUSA
  4. 4.Harvard Medical SchoolBostonUSA
  5. 5.Uniformed Services University of the Health SciencesBethesdaUSA

Personalised recommendations