Pediatric inguinal hernia: Outcome of repair

Objectives: Controversial issues in the diagnosis and management of inguina l hernia in children, with a relatively high rate of reported postoperative complications (up to 8%), suggested the examination of our current policy in the management of pediatric inguinal hernia. The determination of risk f actors, predisposing to postoperative complication may be identified so as to improve postoperative outcome. Methods: A prospective audit of 499 children with inguinal hernias, treated in a teaching hospital between 1987 and 1995 was performed. A detailed pro tocol was used to record the data. There were 394 boys and 105 girls betwee n one day and 14 years of age. There were 130 (26%) neonates. Out of 499 pa tients, 478 were operated upon either electively (429) or as emergency (46) . Results: The hernia was correctly diagnosed by the parents 366 times and by a physician 118 times. All emergency cases underwent a routine attempt of conservative reduction; this was successful in 33 of 46 (56%) cases, Patien ts discharged after conservative reduction for delayed elective operation d efaulted in 12 of 33 (36.4%) cases. A hernia appearance on the opposite sid e was noticed in 17 (3.4%) cases. In 5% complications such as wound infecti on, recurrence, misplaced testis, respiratory distress, ileus, bleeding per rectum and anesthesia were recorded. Low educational level of the surgeon, prematurity, younger age or both of the patient and emergency operation we re identified as risk factors predisposing to complications. Conclusion: Parental finding of an inguinal swelling is an acceptable diagn osis for hernia in children. Failure to demonstrate the hernia should not b e considered an indication for invasive diagnostic procedure like herniogra phy. Following conservative reduction, herniotomy must be performed within 24-48 hours because of high rate of default (36.4%), if herniotomy is delay ed. We do not advocate a routine contralateral exploration as the incidence of the appearance of a hernia is small (3.4%). Pediatric herniotomy is not a suitable operation for unsupervised training.