Herniorraphy or Hernioplasty for Inguinal Hernia in Infants Under One Year
All inguinal hernias in infants under one year should be surgically repaired to prevent the risk of bowel incarceration and gonadal infarction/atrophy, with both open herniorraphy and laparoscopic approaches being appropriate options. 1, 2
Rationale for Surgical Repair in Infants
- Inguinal hernias in infants result from incomplete involution of the processus vaginalis, creating a patent processus vaginalis (PPV) through which intra-abdominal structures can herniate 1
- The prevalence of PPV is highest during infancy (up to 80% in term male infants) and declines with age 1, 2
- More than 90% of pediatric inguinal hernias occur in boys, with 60% occurring on the right side 1
- Infants under 1 year are approximately 60 times more susceptible to incarcerated hernias compared to older children 3
Surgical Approach Options
Open Inguinal Hernia Repair (OIHR)
- Can be performed under regional or general anesthesia 4
- Permits direct visualization of the spermatic cord (in males) and high ligation of the hernia sac 4
- Generally has shorter operative time than laparoscopic repair for unilateral hernias 3
- Particularly beneficial for male patients with unilateral and complete inguinal hernias 3
Laparoscopic Inguinal Hernia Repair (LIHR)
- Requires general anesthesia 4
- Allows same-setting visualization of the contralateral inguinal ring and repair of any contralateral hernia 4
- Highly recommended for female patients 3
- Has been demonstrated as safe and effective even in newborns and ex-preterm infants 5
Timing of Repair
- While all inguinal hernias in infants should be repaired, the timing can be planned electively in most cases 6
- Recent evidence suggests that complications while awaiting elective repair may be less common than previously thought 6
- Only 2% of preterm and 1% of full-term infants discharged without immediate hernia repair required inguinal hernia repair during unplanned readmissions 6
- Premature infants undergoing repair after NICU discharge had fewer adverse events and shorter hospital stays than those undergoing surgery while in the NICU 4
Special Considerations
- Female infants and those under 1 year have higher rates of incarceration 3
- Surgeons should be vigilant for ovary hernias in female infants 3
- The physical features of the hernia (size of defect, amount of herniating intestine, ease of reduction) do not consistently predict incarceration risk 1, 2
- Incarcerated hernias are associated with longer operative time, hospital stay, and higher costs 3
Complications to Monitor
- Potential complications include hernia recurrence, vas deferens injury, and testicular atrophy 1
- Infection is a possible complication of repair 2
- Testicular complications in males are a potential risk 2
Mesh Use Considerations
- Traditional pediatric inguinal hernia repair typically involves herniotomy (high ligation of the hernia sac) without mesh placement 7
- Mesh reinforcement is more commonly used in adults and is generally not necessary for infants under one year 7
- Herniotomy without mesh has shown excellent outcomes in younger patients, with one study showing zero recurrences in patients up to 25 years of age 7