title: The management of boys under 3 months of age with an inguinal hernia and ipsilateral palpable undescended testis.
abstract: OBJECTIVE
  The optimal management for boys under 3 months of age with an indirect inguinal hernia (IIH) and ipsilateral palpable undescended testis (IPUDT) is unknown. We aimed to: 1) determine the current practice for managing these boys across the UK, and 2) compare outcomes of different treatment strategies.
  
  
  METHODS
  We undertook two studies. Firstly, we completed a National Survey of all surgeons on the British Association of Paediatric Surgeons email list in 2014. Subsequently, we undertook a multi-centre, retrospective, 10-year (2005-2015) review across 4 pediatric surgery centers of boys under 3months of age with concomitant IIH and IPUDT. Primary outcome was testicular atrophy. Secondary outcomes included need for subsequent orchidopexy, testicular ascent and hernia recurrence. Data are presented as median (range). Chi-squared test and multivariate binomial logistic regression analysis were used for analysis; p<0.05 was considered significant.
  
  
  RESULTS
  Survey: Consultant practice varies widely across the UK, with a tendency towards performing concurrent orchidopexy at the time of herniotomy under 3 months of age. Concurrent orchidopexy is favored less in cases where the hernia is symptomatic. Case Series Review: Forty-one boys with 43 concomitant IIH and IPUDT were identified, and all included. 32 (74%) hernias were reducible, 11 (26%) were symptomatic requiring urgent or emergency repair. Post-conceptual age at surgery was 45weeks (36-65). Primary operations included: 29 (67%) open hernia repair and standard orchidopexy, 8 (19%) open hernia repair with future orchidopexy if required, 4 (9%) laparoscopic hernia repair with future orchidopexy if required, 2 (5%) open hernia repair and suturing of the testis to the inverted scrotum without scrotal incision. Variation in atrophy rate between different surgical approaches did not reach statistical significance (p=0.42). Overall atrophy rate was 18%. If hernia repair alone was undertaken (8 open and 4 laparoscopic), the testis did not descend in 8 patients, requiring subsequent orchidopexy (67%); if orchidopexy was undertaken at the time of hernia repair, 1 in 29 required a repeat orchidopexy (3%) (p=0.0001). No hernia recurred.
  
  
  CONCLUSIONS
  This study suggests that orchidopexy at the time of inguinal herniotomy does not increase the risk of testicular atrophy in boys under 3months of age.
authors.affiliation: Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK; Department of Paediatric Surgery, University Hospital Lewisham, London, UK. Electronic address: naomiwright@doctors.org.uk.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Wright
authors.affiliation: Department of Paediatric Surgery, University Hospital Lewisham, London, UK.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Davidson
authors.affiliation: Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Major
authors.affiliation: Department of Paediatric Surgery, King's College Hospital, London, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Durkin
authors.affiliation: Department of Paediatric Surgery, King's College Hospital, London, UK.
authors.forename: Yew-Wei
authors.initials: YW
authors.lastname: Tan
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jobson
authors.affiliation: Department of Paediatric Surgery, King's College Hospital, London, UK.
authors.forename: Niyi
authors.initials: N
authors.lastname: Ade-Ajayi
authors.affiliation: Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
authors.affiliation: Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK; Department of Paediatric Surgery, University Hospital Lewisham, London, UK.
authors.forename: Nordeen
authors.initials: N
authors.lastname: Bouhadiba
mesh_terms: D003456:Cryptorchidism / Q000150:complications / Q000601:surgery*; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D056126:Orchiopexy / Q000379:methods / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Inguinal hernia; Neonatal; Pediatric; Premature; Testicular atrophy; Undescended testis