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An indirect inguinal hernia is a common cause for evaluation, with a higher incidence in boys and premature/low birth weight infants.
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Benefits of early repair include avoiding the risk of incarceration/strangulation versus the benefits of delayed repair include minimizing the cardiopulmonary risks of anesthesia and decreasing the risk of recurrence.
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There is variability among pediatric surgeons with regards to exploring the contralateral side; the risk of developing a hernia with a patent
Inguinal and Other Hernias
Section snippets
Key points
Embryology
The inguinal hernia in the neonate is the result of an arrest of normal embryologic development. Beginning around 12 weeks of gestation, a “finger” of peritoneum enters the inguinal canal and descends into the scrotum as the processus vaginalis in boys. This process is followed by descent of the testes between 28 and 36 weeks of gestation. The processus then closes and is obliterated by 36 to 40 weeks of gestation, although 40% of patent processus vaginalis may close within the first few months
Umbilical hernia
All neonates have a defect at the umbilicus through which the umbilical vessels traverse. This defect closes spontaneously in the majority during the early days to weeks of infancy. An umbilical hernia is present in 15% to 23% of newborns, and the incidence is higher in premature and low birth weight infants compared with term infants [42]. In a recent systematic review, a large majority of umbilical hernias (>90%) close spontaneously without surgical intervention within the first couple of
Epigastric hernia
Epigastric hernias or congenital ventral hernias are usually superior to the umbilicus and the result of failure of the linea alba to approximate in the midline during the final stages of abdominal wall development. They comprise 4% of all pediatric hernias and approximately one-half are symptomatic or enlarging [48]. Surgical repair is recommended in an elective fashion, usually performed via an open approach. An ultrasound-guided approach has also been described, performed similarly as for
Rare pediatric hernias
Direct inguinal hernias and femoral hernias are a rare occurrence in the pediatric population with a reported incidence of 0.2% to 2.0% and 0.2% to 1.0%, respectively [50,51]. These hernias are difficult to diagnose clinically, and recently more are being identified with the advent of laparoscopy and laparoscopic repair of inguinal hernias. Both direct and femoral hernias have been found in the setting of recurrence after open inguinal hernia repair (which may have been misdiagnoses initially).
Summary
Despite being a common diagnosis and procedure, there is still significant variability in practice patterns with regards to surgical management of pediatric hernias, especially in the former preterm infant with an inguinal hernia.
Disclosure
The authors have nothing to disclose.
References (52)
- et al.
The patent processus vaginalis and the inguinal hernia
J Pediatr Surg
(1969) Pediatric hernias
Surg Clin North Am
(2008)- et al.
Inguinal hernias in very low birth weight infants: incidence and timing of repair
J Pediatr Surg
(1992) - et al.
Prematurity, not age at operation or incarceration, impacts complication rates of inguinal hernia repair
J Pediatr Surg
(2011) - et al.
American Academy of Pediatrics Section on Surgery hernia survey revisited
J Pediatr Surg
(2005) - et al.
Does timing of neonatal inguinal hernia repair affect outcomes?
J Pediatr Surg
(2015) - et al.
Does timing matter? a national perspective on the risk of incarceration in premature neonates with inguinal hernia
J Pediatr
(2011) - et al.
Optimal timing for inguinal hernia repair in premature infants: a systematic review and meta-analysis
J Pediatr Surg
(2019) - et al.
A critical review of premature infants with inguinal hernias: optimal timing of repair, incarceration risk, and postoperative apnea
J Pediatr Surg
(2011) - et al.
Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review
J Pediatr Surg
(2006)
Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary center
J Pediatr Surg
Preoperative ultrasound and intraoperative findings of inguinal hernias in children: a prospective study of 642 children
J Pediatr Surg
Infant communicating hydroceles—do they need immediate repair or might some clinically resolve?
J Pediatr Surg
Surgery for hydrocele in children—an avoidable excess?
J Pediatr Surg
Incarceration of inguinal hernia in infants prior to elective repair
J Pediatr Surg
Pediatric inguinal and scrotal surgery - Practice patterns in U.S. academic centers
J Pediatr Surg
Variability of inguinal hernia surgical technique: a survey of North American pediatric surgeons
J Pediatr Surg
Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era
Semin Pediatr Surg
Gender-related differences of inguinal hernia and asymptomatic patent processus vaginalis in term and preterm infants
J Pediatr Surg
The risk of developing a symptomatic inguinal hernia in children with an asymptomatic patent processus vaginalis
J Pediatr Surg
Incidence of metachronous contralateral inguinal hernias in children following unilateral repair - A meta-analysis of prospective studies
J Pediatr Surg
Management of asymptomatic pediatric umbilical hernias: a systematic review
J Pediatr Surg
Fifty-three–year experience with pediatric umbilical hernia repairs
J Pediatr Surg
Presentation and management of epigastric hernias in children
J Pediatr Surg
Pediatric abdominal wall defects
Surg Clin North Am
Hernias and hydroceles
Pediatr Rev
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