Pourya Masoudian1, Katrina J Sullivan2, Hisham Mohamed3, Ahmed Nasr4. 1. Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5. Electronic address: pmaso015@uottawa.ca. 2. Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1. Electronic address: ksullivan@cheo.on.ca. 3. Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1. Electronic address: hishammohamed1410@gmail.com. 4. Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1. Electronic address: anasr@cheo.on.ca.
Abstract
BACKGROUND: The optimal timing of repair for inguinal hernia in premature infants remains a controversial topic. Our objective was to assess the clinical effects of inguinal hernia repair done before or after neonatal intensive care unit (NICU) discharge. METHODS: MEDLINE, Embase, CINAHL, and CENTRAL were searched in July 2018. Publications comparing clinical outcomes of the premature infants with inguinal hernia repair before (early) and after (delayed) NICU discharge were identified. Two reviewers independently screened studies, extracted data, and assessed for quality. Results were pooled using random effects meta-analysis. RESULTS: Of 640 publications identified, six comparative studies assessing a total of 1761 premature infants were included. Meta-analysis indicated no statistically significant difference in incarceration rate (odds ratio (OR) 2.15, 95% confidence interval (CI) 0.83-5.58, I2 = 0%), surgical complications (OR 2.36, 95% CI 0.66-8.41, I2 = 0%) and other secondary complications. However, the odds of recurrence and respiratory difficulty was significantly increase in the early group compared to delayed (OR 4.12, 95% CI 1.17-14.45, I2 = 0%; OR 3.59, 95% CI 1.10-11.75, I2 = 42%). CONCLUSIONS: Repair of inguinal hernia in premature infants before NICU discharge may increase the odds of recurrence, but not incarceration or surgical complications. LEVEL OF EVIDENCE: Level III.
BACKGROUND: The optimal timing of repair for inguinal hernia in premature infants remains a controversial topic. Our objective was to assess the clinical effects of inguinal hernia repair done before or after neonatal intensive care unit (NICU) discharge. METHODS: MEDLINE, Embase, CINAHL, and CENTRAL were searched in July 2018. Publications comparing clinical outcomes of the premature infants with inguinal hernia repair before (early) and after (delayed) NICU discharge were identified. Two reviewers independently screened studies, extracted data, and assessed for quality. Results were pooled using random effects meta-analysis. RESULTS: Of 640 publications identified, six comparative studies assessing a total of 1761 premature infants were included. Meta-analysis indicated no statistically significant difference in incarceration rate (odds ratio (OR) 2.15, 95% confidence interval (CI) 0.83-5.58, I2 = 0%), surgical complications (OR 2.36, 95% CI 0.66-8.41, I2 = 0%) and other secondary complications. However, the odds of recurrence and respiratory difficulty was significantly increase in the early group compared to delayed (OR 4.12, 95% CI 1.17-14.45, I2 = 0%; OR 3.59, 95% CI 1.10-11.75, I2 = 42%). CONCLUSIONS: Repair of inguinal hernia in premature infants before NICU discharge may increase the odds of recurrence, but not incarceration or surgical complications. LEVEL OF EVIDENCE: Level III.
Authors: Andrew Hu; Audra J Reiter; Rodrigo Gerardo; Nicholas J Skertich; Ruth Lewit; Muhammad Ghani; Amanda Witte; Hae-Sung Kang; Holden Richards; Bradley Perry; Yao Tian; Steven C Mehl; Andres Gonzalez; Nathan M Novotny; Jeffrey Haynes; Arturo Aranda; Irving J Zamora; Daniel Rhee; Elizabeth Fialkowski; Bethany J Slater; Kyle Van Arendonk; Ankush Gosain; Monica E Lopez; Mehul V Raval Journal: Surgery Date: 2022-05-20 Impact factor: 4.348