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

Tutku Soyer; Luca Pio; Ramon Gorter; Leopoldo Martinez; Jens Dingemann; Federica Pederiva; Anne Dariel; Elke Zani-Ruttenstock; Mohit Kakar; Nigel J. Hall

doi:10.1055/a-2297-8857

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2024; 34(06): 522-528
DOI: 10.1055/a-2297-8857

Original Article

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

Authors

Tutku Soyer

¹Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkiye
Luca Pio

²Department of Pediatric Surgery, Hôpital Bicêtre APHP, Paris Saclay University, Paris, France
Ramon Gorter

³Department of Pediatric Surgery, Amsterdam UMC, University of Amsterdam & Vrije Universiteit, Amsterdam, Noord-Holland, The Netherlands
Leopoldo Martinez

⁴Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain
Jens Dingemann

⁵Centre of Pediatric Surgery, Hannover Medical School and "Auf der Bult" Children's Hospital Hannover, Hannover, Germany
Federica Pederiva

⁶Department of Pediatric Surgery, "F. Del Ponte Hospital" ASST Settelaghi, Varese, Italy
Anne Dariel

⁷Department of Pediatric Surgery, AP-HM, Marseille, Provence-Alpes-Côte d'Azur, France
Elke Zani-Ruttenstock

⁸Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
Mohit Kakar

⁹Department of Pediatric Surgery, Riga Stradins University & Children's Clinical University Hospital, Riga, Latvia
Nigel J. Hall

¹⁰University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

Abstract

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 < 45 weeks of gestation.

Conclusion There is variation in the practice patterns of pediatric surgeons in the treatment of IH in premature infants. Due to the concern for the high risk of incarceration, IH repair before discharge was the most prevalent practice. Lower risk of postoperative apnea was cited as the most common reason for delaying surgery. Randomized studies are required to establish the optimal timing for IH repair in premature infants.

Keywords

premature - infants - inguinal hernia - pediatric surgery

Full Text

References

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