CAPS Original Paper
Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review

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Abstract

Purpose

This study, by its mere size and uniformity (1 pediatric surgeon), aims to corroborate or refute the teachings and myths of the pediatric inguinal hernia.

Methods

From July 1969 to January 2004, 6361 infants and children with inguinal hernias were seen, operated on, and followed by the senior author. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients. The hospital's research ethics board approved of this study.

Results

The ages ranged from premature to 18 years (mean age, 3.3 years) with a male-to female ratio of 5:1. There were 59% right, 29% left, and 12% bilateral hernias (almost all indirect). Hydroceles were found in 19%. Incarceration occurred in 12%. A modified Ferguson repair was used. An opposite-side hernia developed in 5%, 95% within the first 5 years, and was not sex or age specific. There were 1.2% recurrences, 96% within 5 years. Thirteen percent had ventriculo-peritoneal shunts, 1.2% wound infections, and 0.3% testicular atrophy. There were no postoperative deaths. One percent had a documented hernia disappearance.

Conclusions

Three of our results have not corresponded with previous teachings and myths: (1) a hernia of a premature baby should be fixed sooner than later; (2) routine contralateral groin exploration is not indicated in any situation; and (3) teenage recurrence rate is 4 times greater than the overall series.

Section snippets

Materials and methods

From July 1969 to January 2004 (35 years), 6361 infants and children (average, 182 per year) with inguinal hernias were seen, examined, and operated on by the senior author. The hernias in this series did not include the ones usually found with undescended testes, although some boys did require an orchidopexy with their hernia repair (usually incarcerated).

All the patients who had surgery were operated on by the same pediatric surgeon with his residents. The operative repair (all under general

Results

The ages of the infants and children at the time of operation ranged from premature (<36 weeks) to 18 years (mean, 3.3 years). There were 5343 (84%) males and 1018 (16%) females (ratio, 5:1) with 59% right, 29% left, and 12% bilateral inguinal hernias. Eighty-nine (1.4%) patients were from a set of twins. Premies (<36 weeks) with hernias totaled 191 (3%); 179 were males and 12 were females; 39% had hernias on the right side, 26% on the left, and 35% had bilateral hernias. Most premie hernias

Discussion

Although larger series of pediatric inguinal hernias have been reported (meta-analysis, 15,000 Miltenburg et al [2]; 1 service, 8000 Gross [3]), this is the largest and longest series to date by 1 pediatric surgeon who scrubbed on all of the repairs with his residents. These 6361 inguinal hernia operations (average, 182 per year) comprised 26% of the senior author's more than 23,000 pediatric surgical procedures for more than 35 years from July 1969 to January 2004. No patient with hernia was

References (43)

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Presented at the 37th Annual Meeting of the Canadian Association of Paediatric Surgeons, Quebec, Canada, September 22-25, 2005.

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