[Inguinal hernia in preterm infants - therapeutic problem for neonatologist, anaesthesiologist and paediatric surgeon].
Inguinal hernia in preterm infants is a difficult therapeutic problem because of the risk of anaesthesia and the immaturity of the baby. Despite of high risk of perioperative complications surgical repair of the hernia should be considered before discharge.


OBJECTIVE
evaluation of the perioperative problems in the preterm infants with inguinal hernia.


METHODS
evaluation was performed in 21 preterm infants (gestational age 23-36 weeks, birth weight 450-1370 g) operated because of inguinal hernia between 2002-2007. Various problems related to prematurity were confirmed in all patients. Incarcerated hernia were operated on in 5 patients, in 16 neonates hernia repair was performed as elective surgery. In two of them, few weeks after unilateral hernia repair, operation on the other side was performed because of incarceration. Nine infants were qualified for general anaesthesia, fourteen for spinal anaesthesia. Indications for surgical treatment, method of anaesthesia and early postoperative results were analysed with reference to various problems connected with prematurity such as intraventricular haemorrhage and chronic lung disease.


RESULTS
inclusively 23 operations were performed in 21 infants (gestational age 36-47 weeks, weight 1130 -2750 g). Four of fourteen infants preliminary qualified for spinal anaesthesia turned into general anaesthesia. There were not any problems during the operations. Two patients required short ventilatory support (both with general anaesthesia because of incarcerated hernia). During a follow up examination recurrence of the hernia was not observed in any of the patients.


CONCLUSIONS
despite of high risk of perioperative complications in preterm infants, surgical repair of the inguinal hernia should be considered before discharge. Spinal anaesthesia is a safe alternative for general anaesthesia in preterm infants especially for infants with chronic lung disease.
Sawicka
Ewa
E
Klinika Chirurgii Dzieci i Młodziezy, Instytut Matki i Dziecka, ul. Kasprzaka 17a, Warszawa, Poland. e.sawicka@chello.pl
Boczar
Maria
M
Stankiewicz
Joanna
J
Walczak-Wojtkowska
Iwona
I
Woynarowska
Martyna
M
D000775:Anesthesia, Spinal; D000776:Anesthesiology / Q000592:standards; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D009359:Neonatology / Q000592:standards; D011044:Poland; D012189:Retrospective Studies