Our Summary

This research paper focuses on the treatment methods for inguinal hernia (IH), a type of hernia that occurs in the groin area, in premature infants among the members of the European Pediatric Surgeons’ Association. The researchers used an online survey to learn more about these treatment methods.

They found that 60% of surgeons prefer to fix the hernia before the baby leaves the hospital, especially if there was a previous instance of incarceration, where the hernia gets trapped and can’t be pushed back. Even when there wasn’t a history of incarceration, 56% of surgeons still prefer to operate before discharge. However, for extremely premature infants, less than half of the surgeons delay the surgery until after the baby is discharged.

The main reason for operating before discharge is the risk of incarceration. On the other hand, the main reason for delaying the surgery is to lower the risk of the baby having post-surgery breathing problems. The most common method of surgery was an open approach under general anesthesia.

Less than half of the surgeons examine the other side of the groin that doesn’t have a hernia, and only during the laparoscopic repair, a type of minimally invasive surgery. Also, most surgeons require premature infants to stay overnight in the hospital if they are less than 45 weeks of gestation.

The study concluded that there are differences in how surgeons treat IH in premature infants. More research is needed to find out the best time to repair IH in these infants.

FAQs

  1. What percentage of surgeons prefer to fix the hernia before the baby leaves the hospital?
  2. What is the main reason for operating on the hernia before discharge and why do some surgeons delay the surgery?
  3. What is the most common method of surgery for treating inguinal hernia in premature infants?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric hernia repair is to discuss the timing of the surgery with the surgeon, taking into consideration the risks of incarceration versus the risks of post-surgery complications. It’s important to weigh these factors and make an informed decision regarding the optimal timing for hernia repair in your child.

Suitable For

In summary, pediatric patients who are typically recommended for pediatric hernia repair are premature infants with inguinal hernias, especially those with a history of incarceration or at risk of incarceration. Surgeons may choose to repair the hernia before discharge from the hospital to prevent complications, but in some cases, they may opt to delay surgery to minimize post-operative risks. The most common surgical approach is an open procedure under general anesthesia, with laparoscopic repair being less common. Further research is needed to determine the optimal timing for hernia repair in premature infants.

Timeline

  • Before pediatric hernia repair:
  1. Patient is diagnosed with inguinal hernia during a physical examination.
  2. Surgeon discusses treatment options with the patient and family, including the risks and benefits of surgery.
  3. If surgery is recommended, the patient may undergo preoperative testing and preparation.
  4. Surgery may be scheduled before the patient is discharged from the hospital, especially if there is a risk of incarceration.
  5. Anesthesia is administered, and the hernia is repaired using an open approach or laparoscopic technique.
  • After pediatric hernia repair:
  1. Patient is monitored closely in the recovery room for any complications.
  2. Pain management and wound care are provided to the patient.
  3. Patient may stay overnight in the hospital for observation, especially if they are a premature infant.
  4. Follow-up appointments are scheduled to monitor the patient’s recovery and address any concerns.
  5. Patient is advised on postoperative care, including restrictions on physical activity and signs of complications to watch for.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pediatric hernia repair may include:

  1. What are the risks and benefits of repairing the hernia before discharge versus after discharge?
  2. What factors will you consider when deciding the best timing for the surgery in my child’s case?
  3. What type of anesthesia will be used for the surgery, and what are the potential risks associated with it?
  4. Will my child need to stay overnight in the hospital after the surgery, and if so, what are the reasons for this recommendation?
  5. What is the success rate of the chosen surgical approach in treating pediatric hernias?
  6. Are there any potential long-term effects or complications my child may experience after the surgery?
  7. How often will my child need follow-up appointments after the surgery, and what should I expect during these visits?
  8. Are there any specific restrictions or precautions my child should follow during the recovery period?
  9. What signs or symptoms should I watch for that may indicate a complication after the surgery?
  10. Are there any alternative treatment options or approaches that should be considered for my child’s hernia repair?

Reference

Authors: Soyer T, Pio L, Gorter R, Martinez L, Dingemann J, Pederiva F, Dariel A, Zani-Ruttenstock E, Kakar M, Hall NJ. Journal: Eur J Pediatr Surg. 2024 Dec;34(6):522-528. doi: 10.1055/a-2297-8857. Epub 2024 Apr 2. PMID: 38565193