Neonatal Medicine

  • 제27권3호
  • /
  • Pages.118-125
  • /
  • 2020
  • /
  • 2287-9412(pISSN)
  • /
  • 2287-9803(eISSN)
대한신생아학회 (The Korean Society of Neonatology)
권호 표지
DOI QR코드

DOI QR Code

Inguinal Hernia in Preterm Infants: Optimal Timing of Herniorrhaphy to Prevent Preoperative Incarceration and Postoperative Apnea

  • Shin, Jaeho (Division of Pediatric Surgery, Department of Surgery, Inje University Busan Paik Hospital) ;
  • Jeon, Ga Won (Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine)
  • 투고 : 2020.05.10
  • 심사 : 2020.07.19
  • 발행 : 2020.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The objective of this study was to determine the optimal timing of inguinal herniorrhaphy in preterm infants to reduce the risks of preoperative incarceration and postoperative complications. Methods: Preterm infants with gestational age (GA) of <37 weeks who had inguinal herniorrhaphy before the age of 6 months were enrolled. Early repair was defined as undergoing herniorrhaphy before discharge from the neonatal intensive care unit (NICU), and late repair was defined as undergoing herniorrhaphy as an outpatient after discharge from the NICU. Results: The incidence rates of preoperative incarceration and recurrence were not significantly different between the two groups. Postoperative apnea and mechanical ventilation were more frequent in the early-repair group than in the late-repair group. Postoperative apnea was more frequent in the early-repair group after adjustments for GA and birth weight. However, no significant difference in postoperative mechanical ventilation was found between the two groups after adjustments for GA and birth weight. The incidence of postoperative apnea was associated with small weight at repair, early repair, general anesthesia, younger GA, small weight at birth, and bronchopulmonary dysplasia. Contralateral metachronous hernia was most frequent in infants with small weight at repair, early repair, very low birth weight (VLBW), male sex, and right-sided hernia. Conclusion: Late repair was safe and did not increase the risk of incarceration or recurrence, but decreased the risks of postoperative apnea and metachronous hernia. Regional anesthesia could reduce the risk of postoperative apnea. Male infants born with VLBWs and right-sided hernia should be followed up carefully for metachronous hernia.

키워드

참고문헌

  1. Pini Prato A, Casaccia G, Arnoldi R. Timing and management of inguinal hernia in the premature baby. Eur J Pediatr Surg 2017;27:472-7. https://doi.org/10.1055/s-0037-1608802
  2. Khan FA, Zeidan N, Larson SD, Taylor JA, Islam S. Inguinal hernias in premature neonates: exploring optimal timing for repair. Pediatr Surg Int 2018;34:1157-61. https://doi.org/10.1007/s00383-018-4356-8
  3. Kumar VH, Clive J, Rosenkrantz TS, Bourque MD, Hussain N. Inguinal hernia in preterm infants (< or = 32-week gestation). Pediatr Surg Int 2002;18:147-52. https://doi.org/10.1007/s003830100631
  4. Steven M, Greene O, Nelson A, Brindley N. Contralateral inguinal exploration in premature neonates: is it necessary? Pediatr Surg Int 2010;26:703-6. https://doi.org/10.1007/s00383-010-2614-5
  5. Vaos G, Gardikis S, Kambouri K, Sigalas I, Kourakis G, Petoussis G. Optimal timing for repair of an inguinal hernia in premature infants. Pediatr Surg Int 2010;26:379-85. https://doi.org/10.1007/s00383-010-2573-x
  6. Gholoum S, Baird R, Laberge JM, Puligandla PS. Incarceration rates in pediatric inguinal hernia: do not trust the coding. J Pediatr Surg 2010;45:1007-11. https://doi.org/10.1016/j.jpedsurg.2010.02.033
  7. Pini Prato A, Rossi V, Mosconi M, Disma N, Mameli L, Montobbio G, et al. Inguinal hernia in neonates and ex-preterm: complications, timing and need for routine contralateral exploration. Pediatr Surg Int 2015;31:131-6. https://doi.org/10.1007/s00383-014-3638-z
  8. Duggan EM, Patel VP, Blakely ML. Inguinal hernia repair in premature infants: more questions than answers. Arch Dis Child Fetal Neonatal Ed 2015;100:F286-8. https://doi.org/10.1136/archdischild-2012-302964
  9. Masoudian P, Sullivan KJ, Mohamed H, Nasr A. Optimal timing for inguinal hernia repair in premature infants: a systematic review and meta-analysis. J Pediatr Surg 2019;54:1539-45. https://doi.org/10.1016/j.jpedsurg.2018.11.002
  10. Youn JK, Kim HY, Huh YJ, Han JW, Kim SH, Oh C, et al. Inguinal hernia in preterms in neonatal intensive care units: optimal timing of herniorrhaphy and necessity of contralateral exploration in unilateral presentation. J Pediatr Surg 2018;53: 2155-9. https://doi.org/10.1016/j.jpedsurg.2018.02.056
  11. Lee SL, Gleason JM, Sydorak RM. A critical review of premature infants with inguinal hernias: optimal timing of repair, incarceration risk, and postoperative apnea. J Pediatr Surg 2011;46: 217-20. https://doi.org/10.1016/j.jpedsurg.2010.09.094
  12. Antonoff MB, Kreykes NS, Saltzman DA, Acton RD. American Academy of Pediatrics section on surgery hernia survey revisited. J Pediatr Surg 2005;40:1009-14. https://doi.org/10.1016/j.jpedsurg.2005.03.018
  13. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. Lancet 2006;367:1421-31. https://doi.org/10.1016/S0140-6736(06)68615-7
  14. Lee CH, Chen Y, Cheng CF, Yao CL, Wu JC, Yin WY, et al. Incidence of and risk factors for pediatric metachronous contralateral inguinal hernia: analysis of a 17-year nationwide database in Taiwan. PLoS One 2016;11:e0163278. https://doi.org/10.1371/journal.pone.0163278
  15. Sulkowski JP, Cooper JN, Duggan EM, Balci O, Anandalwar SP, Blakely ML, et al. Does timing of neonatal inguinal hernia repair affect outcomes? J Pediatr Surg 2015;50:171-6. https://doi.org/10.1016/j.jpedsurg.2014.10.035
  16. Gulack BC, Greenberg R, Clark RH, Miranda ML, Blakely ML, Rice HE, et al. A multi-institution analysis of predictors of timing of inguinal hernia repair among premature infants. J Pediatr Surg 2018;53:784-8. https://doi.org/10.1016/j.jpedsurg.2017.09.009
  17. Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 2006;41:980-6. https://doi.org/10.1016/j.jpedsurg.2006.01.020
  18. Hughes K, Horwood JF, Clements C, Leyland D, Corbett HJ. Complications of inguinal herniotomy are comparable in term and premature infants. Hernia 2016;20:565-9. https://doi.org/10.1007/s10029-015-1454-6
  19. de Goede B, Verhelst J, van Kempen BJ, Baartmans MG, Langeveld HR, Halm JA, et al. Very low birth weight is an independent risk factor for emergency surgery in premature infants with inguinal hernia. J Am Coll Surg 2015;220:347-52. https://doi.org/10.1016/j.jamcollsurg.2014.11.023
  20. Fu YW, Pan ML, Hsu YJ, Chin TW. A nationwide survey of incidence rates and risk factors of inguinal hernia in preterm children. Pediatr Surg Int 2018;34:91-5. https://doi.org/10.1007/s00383-017-4222-0
  21. Chang SJ, Chen JY, Hsu CK, Chuang FC, Yang SS. The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study. Hernia 2016;20:559-63. https://doi.org/10.1007/s10029-015-1450-x
  22. Olesen CS, Mortensen LQ, Oberg S, Rosenberg J. Risk of incarceration in children with inguinal hernia: a systematic review. Hernia 2019;23:245-54. https://doi.org/10.1007/s10029-019-01877-0
  23. Jones LJ, Craven PD, Lakkundi A, Foster JP, Badawi N. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev 2015;2015:CD003669.
  24. Gurria J, Kuo P, Kao A, Christensen L, Holterman A. General endotracheal vs. non-endotracheal regional anesthesia for elective inguinal hernia surgery in very preterm neonates: a single institution experience. J Pediatr Surg 2017;52:56-9. https://doi.org/10.1016/j.jpedsurg.2016.10.019
  25. Fraser JD, Snyder CL. Inguinal hernias and hydroceles. In: Holcomb GW, Murphy JP, Ostlie DJ, editors. Ashcraft's pediatric surgery. 6th ed. London: Saunders/Elsevier, 2014:679-88.
  26. Demouron M, Delforge X, Buisson P, Hamzy M, Klein C, Haraux E. Is contralateral inguinal exploration necessary in preterm girls undergoing inguinal hernia repair during the first months of life? Pediatr Surg Int 2018;34:1151-5. https://doi.org/10.1007/s00383-018-4334-1
  27. Zamakhshardy M, Ein A, Ein SH, Wales PW. Predictors of metachronous inguinal hernias in children. Pediatr Surg Int 2009;25:69-71. https://doi.org/10.1007/s00383-008-2286-6
  28. Burgmeier C, Dreyhaupt J, Schier F. Comparison of inguinal hernia and asymptomatic patent processus vaginalis in term and preterm infants. J Pediatr Surg 2014;49:1416-8. https://doi.org/10.1016/j.jpedsurg.2014.03.013