Contralateral inguinal exploration in premature neonates: is it necessary?
OBJECTIVE
The purpose of this study was to review our management of neonatal inguinal hernias in premature infants over a 5-year period to ascertain any change in practice.


METHODS
Premature infants who underwent inguinal herniotomy between 2002 and 2006 were identified. Case notes were analyzed recording patient demographics, primary side, complications, recurrence and how many re-presented with a metachronous hernia.


RESULTS
172 preterm infants were identified: 162 males (94.2%) and 10 females (5.8%). Median gestation was 31 weeks (25-36.7). Eighteen (10.4%) were incarcerated. Median age at surgery was 66.5 days (0-284). Thirty-two (18.6%) had bilateral hernias. Of the 63 who underwent unilateral herniotomy, 9 (14.3%) re-presented with a metachronous hernia. Median time to returning was 24 days. The number of contralateral explorations decreased over the study period. The complication rate was 6.4%. Median follow-up was 2.83 years (0.33-5.4).


CONCLUSIONS
This is one of the largest series showing the current practice in managing preterm infants with inguinal hernia. There are limitations to this study and the follow-up period is short. The value of contralateral groin exploration in premature neonates remains doubtful and we have shown that the overall practice has changed.
Steven
Mairi
M
Department of Surgical Pediatrics, Royal Hospital for Sick Children, Dalnair Street, Glasgow, G3 8SJ, UK. mairisteven@doctors.org.uk
Greene
Owen
O
Nelson
Adam
A
Brindley
Nicola
N
D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000639:trends
Surg Endosc. 2009 Jan;23(1):103-7
18528614
J Urol. 2002 Apr;167(4):1818-20
11912440
J Pediatr Surg. 1969 Feb;4(1):102-7
5779274
J Pediatr Surg. 1997 Mar;32(3):445-7
9094014
J Pediatr Surg. 1999 May;34(5):684-7; discussion 687-8
10359164
Am J Surg Pathol. 1999 Aug;23(8):869-71
10435553
Acta Paediatr. 2001 Apr;90(4):370-1
11332924
J Pediatr Surg. 1995 Aug;30(8):1195-7
7472981
J Pediatr Surg. 2006 Dec;41(12):2004-7
17161192
J Pediatr Urol. 2008 Apr;4(2):141-5
18631911
Am J Surg Pathol. 1999 Aug;23(8):880-5
10435556
Eur J Pediatr Surg. 2009 Jun;19(3):145-7
19347803
Pediatr Surg Int. 1999;15(1):36-9
9914352