European Pediatric Surgeons' Association Survey on Timing of Inguinal Hernia Repair in Premature Infants

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Aim This article evaluates the practice patterns of European Pediatric Surgeons' Association (EUPSA) members regarding the timing of inguinal hernia (IH) repair in premature infants. Methods Online survey containing 29 questions distributed to EUPSA members during January 2023. Results A total of 180 responds were received. Overall, IH repair prior to discharge was favored by 60% of respondents when there was a history of incarceration and 56% when there was not. In the case of very/extremely premature infants (< 32 weeks) with no history of incarceration, fewer (43%) respondents postpone the surgery until after discharge. The majority of respondents cited the risk of incarceration as the reason for advocating surgery prior to discharge, whereas a reduced risk of apnea was the most cited reason for respondents who prefer delayed surgery. Open approach under general anesthesia was favored by 54% of respondents, with 27% of them preferring open approach with spinal anesthesia. Laparoscopic surgery for premature infants is used in 11% while 7% of them preferred in all premature infants including extremely/very premature ones. Contralateral side evaluation was never done by 40% of respondents and 29% only performed it only during laparoscopic repair. The majority of respondents (77%) indicated that they have an overnight stay policy for premature infants

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Article · Apr 2024 · 1 min read

In brief

This EUPSA survey of 180 European pediatric surgeons reveals divided practice on timing inguinal hernia repair in premature infants, with 56-60% favoring pre-discharge surgery to prevent incarceration while others delay to reduce apnea risk. Open repair under general anesthesia remains most common (54%), though spinal anesthesia and laparoscopic approaches are gaining adoption in select centers.

60% of European pediatric surgeons repair inguinal hernias before NICU discharge when incarceration history exists, 56% without history.
For extremely premature infants (<32 weeks), only 43% delay surgery until after discharge, citing incarceration risk as primary concern.
Open repair under general anesthesia remains most common (54%), though 27% use spinal anesthesia; laparoscopy used in only 11% of cases.
40% of surgeons never evaluate the contralateral side; 29% only check during laparoscopic repair, suggesting inconsistent practice patterns.
77% mandate overnight observation post-repair for premature infants, reflecting concern for postoperative apnea and cardiorespiratory events.

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