Indian Pediatrics - Editorial

Letters to the Editor

Indian Pediatrics 2003; 40:913

Inguinal Hernias in Babies

Inguinal hernia is one of the commonest surgical conditions encountered in pediatric practice. The incidence varies according to gestational age and is more common in boys and on the right side(l). The recommendation on the timing for surgery on inguinal hernia in a premature baby and neonate in western world is well established.It is based on high incidence of incarceration reported to be as high as 25% and its attendent morbidity and mortality. Based on this data, a premature baby with inguinal hernia is operated before discharge from nursery, a term newborn with hernia is operated in the next available elective list and an infant is put on the waiting list to be done on priority(2,3).

We conducted an audit of all inguinal hernias presenting to our department in babies less than one year over a fifteen month period (July 2000-Sept 2001). The patient data obtained was tabulated and stratified into two groups. Group A included babies less than three months and Group B included babies more than three months. One hundred and thirty babies less than twelve months of age were managed for inguinal hernia during the given period. There were one hundred and twenty five boys (96%) and seventy three had right sided hernia (56%). Six babies had bilateral inguinal hernia. Ninety (70%)were between 3-12 months of age (Group B). None of them presented with incarceration. All had elective herniotomy without mortality or morbidity. The minmum period of follow up was one month.

There were forty babies (30%) below three months of age (Group B). Seven (17.5%) of these presented with complications of inguinal hernia and required admission into neonatal intensive care unit for management. One boy (term, 7 days) who had presented with five days of incarceration died in the preoperative period due to refractory septicemic shock. Another septic preterm baby with broncho-pulmonary dysplasia and right sided irreducible hernia associated with left sided reducible hernia died on the sixth day in the postoperative period. Both required venti-latory support. The five who were successfully managed after emergency surgery underwent emergency operation after initial resuscitation. Each one of them had a difficult perioperative period characterized by septicemia(2), apnea(2) and seizures(2). The thirty three babies who underwent elective operation in Group A had no morbidity or mortality.

The risk of developing a complication of inguinal hernia in babies while waiting for surgery is real and significant. While waiting for the surgery, parents need adequate counselling by the primary physician. The period of waiting should be a balance between the established safety of elective neonatal surgery versus the risk of a surgical complication and its associated morbidity and mortality for the given center.

M.S. Rao,
S.K. Chowdhary,
K.L.N. Rao,
Department of Pediatric Surgery,
PGIMER,Chandigarh 160 012, India.

References

1. Lloyed DA, Rintala RJ. Inguinal hernia and hydrocele. In: O Neill JA, Rowe MI, Grosfield JL, Fonkalsrud FW, Coran AG (Eds). Pediatric Surgery, 5th edn. Missouri, Mosby: 1998; pp. 1072-1073.

2. Rescorla JF, Grosfeld JL. Inguinal hernia repair in early infancy: Clinical considerations. J Pediatr Surgery 1984; 19: 832-833.

3. Misra D, Hewitt SR, Post SR, Brown VE. Inguinal herniotomy in young infants with emphasis on premature neonates. J Pediatr Surgery 1994; 29: 1496-1499.