From the Guidelines
The appropriate age to repair an inguinal hernia in a pediatric patient is typically as soon as the diagnosis is made, regardless of the child's age, to prevent potential complications such as incarceration or strangulation, as supported by studies such as 1 and 1.
Key Considerations
- For otherwise healthy infants and children, elective repair should be performed promptly, as the risk of incarceration is highest in infants under 1 year, with a reported risk of 10-20% 1.
- In premature infants, some surgeons may wait until the baby reaches a weight of 2-2.5 kg or is ready for discharge from the NICU, though this varies by institution, as noted in 1.
- The surgical approach is usually an open repair with high ligation of the hernia sac, performed as an outpatient procedure under general anesthesia, with laparoscopic approaches considered in older children or bilateral cases, as discussed in 1.
Rationale
- Pediatric inguinal hernias do not resolve spontaneously and carry a significant risk of incarceration, which can lead to serious complications such as bowel strangulation and gonadal infarction, as highlighted in 1 and 1.
- Unlike adults, watchful waiting is not recommended for pediatric inguinal hernias due to these risks, and prompt repair is generally advised, as supported by 1.
Additional Factors
- The timing of repair should balance the risks of inguinal hernia incarceration and postoperative respiratory complications, as noted in 1 and 1.
- Contralateral inguinal exploration may be considered in certain cases, although the utility of this approach is still debated, as discussed in 1.
From the Research
Optimal Age for Repairing Inguinal Hernia in Pediatric Patients
The optimal age for repairing an inguinal hernia in pediatric patients is a topic of ongoing debate.
- Studies have shown that the timing of inguinal hernia repair in children varies greatly among surgeons 2.
- For preterm infants, postponing hernia repair until after discharge from the neonatal intensive care unit (NICU) or hospital is associated with less respiratory difficulties and recurrences 3, 4.
- Laparoscopic repair may be beneficial for children with bilateral hernia, as it shortens operative time compared to open repair 3.
- In adolescents, a selective approach to inguinal hernia repair based on the size of the defect appears justified, with no significant difference in recurrence and complications between high ligation of the sac and mesh repair 5.
Considerations for Anesthesia and Surgical Approach
- Regional anesthesia may be considered for preterm infants to reduce postoperative apnea and pain, with no difference in neurodevelopment outcomes 3, 4.
- The choice of surgical approach (open vs. laparoscopic) and anesthesia technique should be individualized based on the patient's specific needs and circumstances.
- Currently available evidence is of moderate-to-low quality, and more research is needed to inform optimal management guidelines for inguinal hernia repair in children 3, 4.