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Treatment of routine adolescent inguinal hernia vastly differs between pediatric surgeons and general surgeons

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Abstract

Background

Surgical treatment of inguinal hernias in adolescents is controversial as these patients do not fit into the traditional pediatric and adult populations. We aimed to compare the preferences of adult general surgeons and pediatric surgeons in managing adolescents by conducting a survey through social media.

Methods

A poll was posted on the International Hernia Collaboration Group Facebook page as well as the Facebook page for the authoring pediatric surgeon. The poll gave scenarios of a 16-year-old male with an inguinal hernia and asked surgeons to select one of five listed procedures to repair the hernia: high ligation (open or laparoscopic), mesh repair (open or laparoscopic) or open muscle repair. The four scenarios differed in the diameter of the internal ring (1 vs. 4 cm) and the BMI of the patient (20 vs. 35). Fisher’s exact test was implemented for statistical analysis.

Results

In total, 43 (67 %) adult surgeons and 21 (33 %) pediatric surgeons responded. In the routine adolescent (normal BMI, small defect), 65 % of adult surgeons chose adult-type repairs (mesh or muscle repairs) whereas 86 % of pediatric surgeons chose pediatric-type repairs (high ligation). When the size of the defect increased, 100 % of adult surgeons and 81 % of pediatric surgeons selected an adult-type repair, suggesting agreement. When the patient was obese, there was a tendency to prefer laparoscopy. In all patient scenarios, the answers were significantly different between pediatric and adult surgeons (p < 0.05).

Conclusion

For the same routine adolescent inguinal hernia, pediatric surgeons and adult general surgeons choose a different procedure. This finding suggests that further study is needed to determine the optimal treatment for inguinal hernias in adolescents, as the type of practitioner to whom the patient is referred, rather than the disease process itself, currently dictates treatment.

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Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, Akron Children’s Hospital, One Perkins Square, Suite 8400, Akron, OH, USA

    Nicholas E. Bruns, Ian C. Glenn, Neil L. McNinch & Todd A. Ponsky

  2. Cleveland Clinic, Cleveland, OH, USA

    Nicholas E. Bruns, Ian C. Glenn & Michael J. Rosen

Authors
  1. Nicholas E. Bruns
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  2. Ian C. Glenn
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  3. Neil L. McNinch
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  4. Michael J. Rosen
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  5. Todd A. Ponsky
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Corresponding author

Correspondence to Todd A. Ponsky.

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Disclosures

Dr. Bruns, Dr. Glenn and Mr. McNinch have no conflicts of interest. Dr. Rosen is a speaker for Davol and Gore, has received research grants from Gore and Miromatrix and is a board member of Ariste Medical. Dr. Ponsky is an owner of GlobalCastMD.

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Bruns, N.E., Glenn, I.C., McNinch, N.L. et al. Treatment of routine adolescent inguinal hernia vastly differs between pediatric surgeons and general surgeons. Surg Endosc 31, 912–916 (2017). https://doi.org/10.1007/s00464-016-5054-z

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  • DOI: https://doi.org/10.1007/s00464-016-5054-z

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