Delayed versus early repair of inguinal hernia in preterm infants: A systematic review and meta-analysis
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Jan 2023 · 1 min read
In brief
In brief
This meta-analysis of six studies comparing early versus delayed inguinal hernia repair in preterm infants found that early repair (before NICU discharge) reduces incarceration risk by 57% but increases postoperative respiratory complications 4-fold. The findings support individualized timing decisions based on patient physiology and family circumstances.
Written by the GCMD Library team from the article.
Objectives: To evaluate the clinical outcomes of herniotomy in preterm infants undergoing early versus delayed repair, the risk factors for complications, and to identify best timing of surgery.
Methods: Medline, Embase and Central databases were searched from inception until 25 Jan 2021 to identify publications comparing the timing of neonatal inguinal hernia repair between early intervention (before discharge from first hospitalization) and delayed (after first hospitalisation discharge) intervention. Inclusion criteria was preterm infants diagnosed with inguinal hernia during neonatal intensive care unit admission. Results were analyzed using fixed and random effects meta-analysis (RevManv5.4).
Results: Out of 721 articles found, six studies were included in the meta-analysis. Patients in the early group had lower odds of developing incarceration [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.34-0.55, I2 = 0%, p < 0.001]; but higher risk of post-operative respiratory complications (OR 4.36, 95% CI 2.13-8.94, I2 = 40%, p < 0.001). No significant differences were reported in recurrence rate (OR 3.10, 95% CI 0.90-10.64, I2 = 0%, p = 0.07) and surgical complication rate (OR 0.94, 95% CI 0.18-4.83, I2 = 0%, p = 0.94) between early and delayed groups.
Conclusion: While early inguinal hernia repair in preterm infants reduces the risk of incarceration, it increases the risk of post-operative respiratory complications compared to delayed repair. Surgeons should discuss the risks and benefits of delaying inguinal hernia repair with the caregivers to make an informed decision best suited to the patient physiology and circumstances.
DOI: 10.1016/j.jpedsurg.2022.07.001