Skip to main content
SpringerLink
Log in

Optimal timing for repair of an inguinal hernia in premature infants

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the optimal timing for inguinal herniotomy in premature infants treated in the neonatal intensive care unit.

Methods

A two-institutional-center retrospective study was performed including 41 prematures at gestational age 28–35 weeks who underwent herniotomy within 1 week of diagnosis [short-waiting group (SWG), median 5 days, n = 25] or more than 1 week after diagnosis [long-waiting group (LWG), median 30.55 days, n = 16]. Gestational age, birthweight, post-conceptional age at diagnosis, age at diagnosis, post-conceptional age at surgery, age at surgery, weight at surgery, timing of surgery, operative time, and occurrence of incarceration, postoperative apnea, hernia recurrence, testicular atrophy, and hospital stay were compared between the two groups. Statistical analysis was performed using one-way ANOVA.

Results

Twelve preoperative episodes of incarceration occurred: three in the SWG and nine in the LWG (P < 0.05). Six infants had apnea postoperatively: four in the SWG and two in the LWG (P > 0.05). Follow-up revealed five hernia recurrences, one in the SWG and four in the LWG (P < 0.05); four testicular atrophies were found, one in the SWG and three in the LWG (P > 0.05).

Conclusion

Early elective herniotomy should be considered in prematures in order to avoid perioperative morbidity and to reduce the risk of incarceration and subsequent testicular ischemia, and hernia recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Uemura S, Woodward AA, Amerena R, Drew J (1999) Early repair of inguinal hernia in premature babies. Pediatr Surg Int 15:36–39

    Article  CAS  PubMed  Google Scholar 

  2. Emberton M, Patel L, Zideman DA, Karim F, Singh MP (1996) Early repair of inguinal hernia in preterm infants with oxygen-dependent bronchopulmonary dysplasia. Acta Paediatr 85:96–99

    Article  CAS  PubMed  Google Scholar 

  3. Groff DB, Nagaraj HS, Pietsch JB (1985) Inguinal hernias in premature infants operated on before discharge from the neonatal intensive care unit. Arch Surg 120:962–963

    CAS  PubMed  Google Scholar 

  4. Kumar VHS, Clive J, Rosenkrantz TS, Bourque MD, Hussain N (2002) Inguinal hernia in preterm infants (≤32-week gestation). Pediatr Surg Int 18(2–3):147–152

    Article  PubMed  Google Scholar 

  5. Santacruz MG, Navarro JM, Goenechea AE, Ceballos A, Zaplana HS, Cobo B (2004) Low prevalence of complications of delayed herniotomy in the extremely premature infant. Acta Paediatr 93:94–98

    Article  Google Scholar 

  6. Barreto MWG, Melo-Filho AA, Neto JO, Zeller CB, Marba S, Sbragia L (2004) Nutritional state and herniorrhaphy in premature infants. Pediatr Surg Int 20:699–703

    Article  PubMed  Google Scholar 

  7. Misra D (2001) Inguinal hernias in premature babies: wait or operate? Acta Paediatr 90:370–371

    Article  CAS  PubMed  Google Scholar 

  8. Coren ME, Madden NP, Haddad M, Lissauer TJ (2001) Incarcerated inguinal hernia in premature babies-a report of two cases. Acta Paediatr 90:453–454

    Article  CAS  PubMed  Google Scholar 

  9. Steward DJ (1982) Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiology 56:304–306

    Article  CAS  PubMed  Google Scholar 

  10. Mayhew JF, Bourke DL, Guinee WS (1987) Evaluation of the premature infant at risk for postoperative complications. Can J Anaesth 34:627–631

    Article  CAS  PubMed  Google Scholar 

  11. Coté CJ, Zaslavsky A, Downes JJ, Kurth CD, Welborn LG, Warner LO, Malviya SV (1995) Postoperative apnea in former preterm infants after inguinal herniorrhaphy: a combined analysis. Anesthesiology 82:809–822

    Article  PubMed  Google Scholar 

  12. Rescorla FJ, Grosfeld JL (1984) Inguinal hernia repair in the perinatal period and early infancy: clinical considerations. J Pediatr Surg 19:832–837

    Article  CAS  PubMed  Google Scholar 

  13. Antonoff MB, Kreykes NS, Saltzman DA, Acton RD (2005) American academy of pediatrics section on surgery hernia survey revisited. J Pediatr Surg 40:1009–1014

    Article  PubMed  Google Scholar 

  14. Wiener ES, Touloukian RJ, Rodgers BM, Grosfeld JL, Smith EI, Ziegler MM, Coran AG (1996) Hernia survey of the section on surgery of the American academy of pediatrics. J Pediatr Surg 31:1166–1169

    Article  CAS  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. Harper RG, Garcia A, Sia C (1975) Inguinal hernia: a common problem of premature infants weighing 1, 000 g or less at birth. Pediatrics 56:112–115

    CAS  PubMed  Google Scholar 

  17. Krieger NR, Shochat SJ, McGowan V, Hartman GE (1994) Early hernia repair in the premature infant: long-term follow-up. J Pediatr Surg 29:978–982

    Article  CAS  PubMed  Google Scholar 

  18. Misra D, Hewitt G, Potts SR, Brown S, Boston VE (1994) Inguinal herniotomy in young infants, with emphasis on premature neonates. J Pediatr Surg 29:1496–1498

    Article  CAS  PubMed  Google Scholar 

  19. Rowe MI, Clatworthy HW (1970) Incarcerated and strangulated hernias in children: a statistical study of high-risk factors. Arch Surg 101:136–139

    CAS  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. Warner LO, Teitelbaum DH, Caniano DA, Vanik PE, Martino JD, Servick JD (1992) Inguinal herniorrhaphy in young infants: perianesthetic complications and associated preanesthetic risk factors. J Clin Anesth 4:455–461

    Article  CAS  PubMed  Google Scholar 

  22. Murphy JJ, Swanson T, Ansermino M, Milner R (2008) The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit? J Pediatr Surg 43:865–868

    Article  PubMed  Google Scholar 

  23. Craven PD, Badawi N, Henderson-Smart DJ, O’Brien M (2003) Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev 3:CD003669

  24. Kim J, Thornton J, Eipe N (2009) Spinal anesthesia for the premature infant: is this really the answer to avoiding postoperative apnea? Paediatr Anaesth 19:56–58

    PubMed  Google Scholar 

  25. William JM, Stoddart PA, Williams SA, Wolf AR (2001) Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia. Br J Anaesth 86:366–371

    Article  CAS  PubMed  Google Scholar 

  26. Lloyd DA, Rintala RJ (1998) Inguinal hernia and hydrocele. In: O’Neill JA Jr, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (eds) Pediatric surgery, 5th edn. Mosby, St. Louis, pp 1071–1086

    Google Scholar 

  27. Steinau G, Treutner KH, Feeken G, Schumpelick V (1995) Recurrent inguinal hernias in infants and children. World J Surg 19:303–306

    Article  CAS  PubMed  Google Scholar 

  28. Vogels HD, Bruijnen CJ, Beasly SW (2009) Predictors of recurrence after inguinal herniotomy in boys. Pediatr Surg Int 25:235–238

    Article  PubMed  Google Scholar 

  29. Fahlstrom C, Holmberg L, Johansson H (1963) Atrophy of the testis following operations upon the inguinal region in infants and children. Acta Chir Scand 126:221–232

    Google Scholar 

  30. Murdoch RWG (1979) Testicular strangulation from incarcerated inguinal hernia in Infants. J R Coll Surg Edinb 24:97–101

    CAS  PubMed  Google Scholar 

  31. Rescorla FJ (1991) Incarcerated inguinal hernia in an infant. In: Grosfeld JL (ed) Common problems in pediatric surgery. Mosby, St Louis, pp 9–16

    Google Scholar 

  32. Miserez M (2004) Inguinal hernia repair in a premature infant. J Pediatr Surg 39:252

    Article  CAS  PubMed  Google Scholar 

  33. IPOKRaTES international: international postgraduate organization for knowledge transfer research and teaching excellent students. Available from: http://www.ipokrates.info

Download references

Acknowledgments

The authors would like to thank the staff of the NICUs of the Alexandroupolis University Hospital Alexandroupolis, Greece and P and A Kyriakou Children’s Hospital, Athens, Greece for medical care of these infants and Assistant Professor Trypsianis Gregorios, PhD of the Department of Medical Statistics, Democritus University of Thrace School of Medicine, Alexandroupolis, Greece and Dr George Vassaras MD, Alexandroupolis, Greece for their statistical evaluation.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace School of Medicine, 68100, Alexandroupolis, Greece

    George Vaos, Stefanos Gardikis & Katerina Kambouri

  2. Department of Neonatology, Alexandroupolis University Hospital, Alexandroupolis, Greece

    Ioannis Sigalas

  3. Department of Neonatology, P and A Kyriakou Children’s Hospital, Athens, Greece

    George Kourakis

  4. First Department of Pediatric Surgery, P and A Kyriakou Children’s Hospital, Athens, Greece

    George Petoussis

Authors
  1. George Vaos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefanos Gardikis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katerina Kambouri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ioannis Sigalas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. George Kourakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George Petoussis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George Vaos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vaos, G., Gardikis, S., Kambouri, K. et al. Optimal timing for repair of an inguinal hernia in premature infants. Pediatr Surg Int 26, 379–385 (2010). https://doi.org/10.1007/s00383-010-2573-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-010-2573-x

Keywords

Search

Navigation