Recurrent inguinal hernias in infants and children

Abstract

The objective of this study was to analyze the etiologic factors possibly associated with the development of recurrent groin hernias in infants and children. For this purpose we analyzed the records of 2754 pediatric patients operated on for primary hernias between 1966 and 1990 at our department who have not had recurrences. They were compared with 28 boys and 4 girls we treated for recurrent hernias during the same period. We found an indirect hernia in 29 cases, a direct hernia in 4 patients, and a femoral hernia in 1 child at the time of reoperation. A significantly high recurrence rate was found to be associated with incarceration (21.9% versus 7.6%), postoperative complications (9.4% versus 1.8%), concomitant diseases (31.2% versus 5.7%), and premature birth. Day case treatment was closely related to concomitant diseases. No impact on the development of recurrences was seen for the surgeons' educational level and the time of day the surgery was performed. Knowledge of the factors contributing to hernia recurrence and perfect surgical technique with reduction of incarcerated hernias and early elective operation may result in fewer recurrences in infants and children.

Predictors of recurrence after inguinal herniotomy in boys

“…The overall recurrence rate in boys in this series was 0.69%, which is relatively low compared with 0.5-3.8% in other series [4][5][6][7], although Borenstein et al [10] recorded a recurrence rate by paediatric surgeons of 0.45%. Detailed prospectively collected data in 341 cases enabled an analysis of those features that were identifiable at the time of initial surgery that may predispose or predict an increased likelihood of later recurrence.…”

“…Harvey et al [14] found a higher recurrence rate among surgeons in training compared with consultant surgeons, probably because 60% of their children under the age of 1 and 76% of emergency operations were operated on by a surgeon in training. Steinau et al [5] did not show that the surgeon's educational level affected recurrence rate. Ten children (62.5%) with recurrence were born prematurely.…”

“…The recurrence rate in prematures is known to be higher, ranging from 2.6-8.6% [2,8,9]. The factors that contribute to recurrence have been largely speculative, and have included strangulation, conditions associated with increased intra-abdominal pressure, occurrence of early postoperative complications (infection, haematoma), connective tissue disorders, and the technical skills of the surgeon [5,[10][11][12]. Until now, there have been no prospective studies relating the operative findings to subsequent recurrence.…”

“…The complication rate of herniotomy is low, but includes recurrence, testicular atrophy, and acquired cryptorchidism. Of these, recurrence is the most frequent and is reported to occur in 0.5-3.8% [4][5][6][7]. The recurrence rate in prematures is known to be higher, ranging from 2.6-8.6% [2,8,9].…”

The use of laparoscopy in the management of Littre’s hernia in children

“…Moreover, repair of incarcerated inguinal hernia was a known risk factor for recurrence of hernia [15]. Edema and distorted anatomy were suggested as the main reasons of recurrence [8].…”