Inguinal Hernia in Premature Infants

Ramachandran, Venkataraman; Edwards, Charles F.; Bichianu, Dana

doi:10.1542/neo.21-6-e392

Cited by 15 publications

(12 citation statements)

References 62 publications

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“…Using genome-wide analysis, four genes involved in the development of IHs were identified. An imbalance between tissue breakdown and rebuilding and decreased strength of inguinal tissues due to defective oxidation of lysine involved in the cross-linking of proteins has been suggested as a possible mechanism [34].…”

Section: Discussionmentioning

confidence: 99%

Fetal Inguinal Hernia: Case Report and Review of the Literature

Liberty,

Shweiki,

Nica

et al. 2023

Fetal Diagn Ther

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Fetal inguinal hernia (FIH) is a rare event, and only a few cases were published in the medical literature. In the present study, we aimed to characterize the sonographic features, clinical presentation, management, outcomes, and differential diagnoses of FIH. Accordingly, we reviewed all 17 cases of FIH published in the medical literature, including one new case evaluated by our group. All 17 cases (100%) were male, and FIH presented as a scrotal mass with a mean diameter of 38±9.5 mm. The right side was dominant (62%). Peristalsis was reported in 80% of the cases, and blood flow was reported in two-thirds. Most cases were diagnosed in the third trimester (88%) at a mean gestational age (GA) of 33.1±5.2W. Sixty percent of the cases had isolated FIH, and 40% had another sonographic or genetic abnormality. Three cases (18%) were syndromic with multiple malformations: trisomy 18, skeletal anomalies due to Jarcho-Levin syndrome, and undefined multiple joint contractures. Two cases (12%) had co-pathologies in the gastrointestinal tract: one had an echogenic bowel due to homozygosity for cystic fibrosis and the other had low anorectal malformation. Bowel loop dilatation was observed prenatally in both cases and in one isolated case (18%). GA at delivery was 38±1.8W, and the median time between diagnosis and delivery was 3 weeks. All three cases of neonatal death occurred in syndromic fetuses. All patients with non-syndromic inguinal hernias underwent definitive surgical repair at a median of 13 days postpartum. No signs of strangulation and only one case of edematous bowel without necrosis have been reported. In conclusion, FIH should be suspected in male fetuses when an intra-scrotal mass with peristalsis is diagnosed during the third trimester. Close follow-up until term in the absence of signs of bowel obstruction is reasonable, and in isolated FIH, the prognosis is favorable.

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Section: Discussionmentioning

confidence: 99%

Fetal Inguinal Hernia: Case Report and Review of the Literature

Liberty,

Shweiki,

Nica

et al. 2023

Fetal Diagn Ther

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“…Infants were eligible for inclusion if they had a diagnosis of inguinal hernia, an estimated gestational age younger than 37 weeks, and were treated in a participating neonatal intensive care unit. Infants were excluded if (1) there were factors affecting the timing of hernia repair, (2) they were undergoing another operative procedure and the inguinal hernia repair was a secondary procedure, (3) there were known major congenital or chromosomal abnormalities that would likely influence the neurodevelopmental outcomes, or (4) the family was unable to return for follow-up and late inguinal hernia repair.…”

Section: Patientsmentioning

confidence: 99%

“…The incidence of inguinal hernia increases as gestational age decreases, reaching 40% in males born at 24 weeks' gestation. 1 Treatment is operative repair to prevent inguinal hernia incarceration (rate range, 5%-28%), 2,3 but the safest timing for repair remains controversial. 4,5 Preterm infants with inguinal hernia usually also have serious comorbidities (eg, acute respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage), 6 and undergoing the repair before discharge from the neonatal intensive care unit has raised concerns for surgical and anesthetic complications, possible prolonged mechanical ventilation, fragility of the tissues involved with the repair, and possible delayed discharge.…”

mentioning

confidence: 99%

“…d Included increased oxygen administration and increase in respiratory support (eg, use of bag and mask ventilation) or the initiation or increase in mechanical ventilation. e Treated with a pharmacological intervention.f Defined as inguinal hernia that is nonreducible(1) and necessitates an urgent inguinal hernia repair; (2) or requires narcotic pain medication or sedation to facilitate inguinal hernia reduction; (3) or requires the pediatric surgery team. g Had a pneumothorax identified after inguinal hernia repair requiring high-frequency oscillator ventilation for 3 days.…”

mentioning

confidence: 99%

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Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants

Blakely,

Krzyzaniak,

Dassinger

et al. 2024

JAMA

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ImportanceInguinal hernia repair in preterm infants is common and is associated with considerable morbidity. Whether the inguinal hernia should be repaired prior to or after discharge from the neonatal intensive care unit is controversial.ObjectiveTo evaluate the safety of early vs late surgical repair for preterm infants with an inguinal hernia.Design, Setting, and ParticipantsA multicenter randomized clinical trial including preterm infants with inguinal hernia diagnosed during initial hospitalization was conducted between September 2013 and April 2021 at 39 US hospitals. Follow-up was completed on January 3, 2023.InterventionsIn the early repair strategy, infants underwent inguinal hernia repair before neonatal intensive care unit discharge. In the late repair strategy, hernia repair was planned after discharge from the neonatal intensive care unit and when the infants were older than 55 weeks’ postmenstrual age.Main Outcomes and MeasuresThe primary outcome was occurrence of any prespecified serious adverse event during the 10-month observation period (determined by a blinded adjudication committee). The secondary outcomes included the total number of days in the hospital during the 10-month observation period.ResultsAmong the 338 randomized infants (172 in the early repair group and 166 in the late repair group), 320 underwent operative repair (86% were male; 2% were Asian, 30% were Black, 16% were Hispanic, 59% were White, and race and ethnicity were unknown in 9% and 4%, respectively; the mean gestational age at birth was 26.6 weeks [SD, 2.8 weeks]; the mean postnatal age at enrollment was 12 weeks [SD, 5 weeks]). Among 308 infants (91%) with complete data (159 in the early repair group and 149 in the late repair group), 44 (28%) in the early repair group vs 27 (18%) in the late repair group had at least 1 serious adverse event (risk difference, −7.9% [95% credible interval, −16.9% to 0%]; 97% bayesian posterior probability of benefit with late repair). The median number of days in the hospital during the 10-month observation period was 19.0 days (IQR, 9.8 to 35.0 days) in the early repair group vs 16.0 days (IQR, 7.0 to 38.0 days) in the late repair group (82% posterior probability of benefit with late repair). In the prespecified subgroup analyses, the probability that late repair reduced the number of infants with at least 1 serious adverse event was higher in infants with a gestational age younger than 28 weeks and in those with bronchopulmonary dysplasia (99% probability of benefit in each subgroup).Conclusions and RelevanceAmong preterm infants with inguinal hernia, the late repair strategy resulted in fewer infants having at least 1 serious adverse event. These findings support delaying inguinal hernia repair until after initial discharge from the neonatal intensive care unit.Trial RegistrationClinicalTrials.gov Identifier: NCT01678638

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“…Tervezett ellátás esetén fél-egy éves kor fölött célszerű végezni a műtétet, csecsemőkben főleg az aneszteziológiai megfontolások miatt. Ennek oka, hogy a fiatal csecsemőkben, egyéves életkor alatt végzett (hosszabb) narkózisok később neurokognitív zavarokat okozhatnak [1]. Sürgős esetben természetesen nem lehet kivárni a fél-egy éves életkort, így a leggyakrabban a lágyéksérv kizáródása miatt indokolt korábban elvégezni a műtétet.…”

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Gyermekkori laparoszkópos lágyéksérvműtét: a betanulási időszak értékelése

Fadgyas

Garai

Deák

et al. 2023

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Bevezetés: A lágyéksérv a leggyakoribb, műtéti ellátást igénylő kórkép gyermekkorban. Célkitűzés: A tanulmány célja a laparoszkópos lágyéksérvműtét (PIRS – percutaneous internal ring suturing) betanulási időszakának vizsgálata volt. Módszer: Prospektív, megfigyelésen alapuló vizsgálatot végeztünk a 2018 és 2019 között elektív PIRS-műtéten átesett 0–18 éves betegek bevonásával. Az akut műtéten (lágyéksérv-kizáródás) átesett betegeket, az egy ülésben más műtétet is igénylő eseteket kizártuk. A műtéti időt, a konverziók és a szövődmények számát, a metakrón sérvek jelenlétét vizsgáltuk. A személyes vizittel járó nyomon követési idő a PIRS-műtétet követően 1–4 hét volt, illetve a betegeket telefonon kerestük meg 2022-ben. Eredmények: A vizsgált időszakban 126 betegben (57 fiú, 69 leány) történt PIRS-műtét, átlagéletkoruk 4,6 év volt. Az átlagos műtéti idő 26,5 perc, szakorvos esetén 22,9 perc volt, s fiúbetegek esetében hosszabbnak bizonyult, mint lányoknál (30,5 vs. 23 perc). Az egyoldali műtétek rövidebbek voltak, mint a kétoldaliak (23,7 vs. 33,6 perc). Kezdetben lányok esetében történt PIRS: folyamatosan csökkent a műtéti idő. Később, amikor szakorvosjelöltek is végeztek már PIRS-műtéteket, azok ismét hosszabbá váltak, majd ismét csökkentek. Hasonló trend figyelhető meg a fiúk műtéteinél. 3 esetben történt konverzió, 3 intraoperatív, 4 posztoperatív szövődményt, 1 recidívát figyeltek meg, 28 metakrón sérv került felismerésre. A telefonos megkeresés során 92/126 beteget értünk el: további 1 recidívát, 6 krónikus panaszt rögzítettünk. Megbeszélés: A PIRS jó laparoszkópos „tanulóműtét” a gyermeksebészek képzésében. A PIRS mellett gyermekkorban helye van a hagyományos lágyéksérvműtétnek is. Következtetés: A PIRS-műtét biztonságos, hamar elsajátítható technika. A metakrón sérvek felismerésében és a szakorvosjelöltek képzésében látható előnye. Orv Hetil. 2023; 164(7): 260–264.

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Inguinal Hernia in Premature Infants

Cited by 15 publications

References 62 publications

Fetal Inguinal Hernia: Case Report and Review of the Literature

Fetal Inguinal Hernia: Case Report and Review of the Literature

Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants

Gyermekkori laparoszkópos lágyéksérvműtét: a betanulási időszak értékelése

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