Delayed versus early repair of inguinal hernia in preterm infants: A systematic review and meta-analysis

Infographic · May 2023 · 1 min read

In brief

Meta-analysis comparing early versus delayed inguinal hernia repair in preterm infants finds early repair reduces incarceration risk but increases post-operative respiratory complications. Surgeons should weigh timing risks individually with families based on patient physiology and clinical circumstances.

Early hernia repair (before NICU discharge) reduces incarceration risk by 57% compared to delayed repair in preterm infants.
Early repair increases postoperative respiratory complications 4-fold; respiratory maturity must be carefully assessed preoperatively.
Recurrence and surgical complication rates are similar between early and delayed repair strategies.
Timing decision requires individualized risk-benefit discussion with families balancing incarceration vs respiratory risk.
No single optimal timing exists; surgeon must weigh patient physiology, social circumstances, and family preferences.

Written by the GCMD Library team from the infographic.

The infographic uses a red, white, and teal color scheme with icons representing hospitals, discharge doors, and surgical instruments. The left panel shows study parameters with a preterm infant illustration. The center panel displays two surgical timing pathways with directional arrows. The right panel presents three outcome measures with arrows indicating direction of effect and warning icons for complications.

New infographic by Dr. Jose Campos and the chilean society of Pediatric surgery

"Delayed versus early repair of inguinal hernia in preterm infants: A systematic review and meta-analysis"

Authors: Candy SC Choo, Yong Chen, Merrill McHoney

DOI: https://doi.org/10.1016/j.jpedsurg.2022.07.001

Abstract

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.

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