Inguino-ScrotalHernia recurrence following inguinal hernia repair in children☆,☆☆,★
Section snippets
Study design and data source
We completed a retrospective cohort study utilizing the Department of Defense Military Health System Data Repository (MDR) and TRICARE insurance program, a previously well described database [14], [15], [16]. The MDR is a longitudinal claims database tracking care delivered to over 9 million members of the U.S. Armed Forces (inactive, active, retired) and their dependents. The MDR has been shown to be a nationally representative sample, and includes a cohort of > 3 million children [17].
Cohort characteristics
There were 3,033,305 children enrolled in TRICARE insurance and the MDR database between 2005 and 2014. We identified 10,025 children ≤ 12 years old who underwent inguinal hernia repair, of whom 9993 met inclusion criteria (Fig. 1). Patient characteristics are shown in Table 1. The greatest proportion of children undergoing initial hernia repair was between the ages of 0-1y (37%), with more than half of repairs performed in children < 3y of age (Table 1). Repairs were predominately performed in
Discussion
Using a large, national database of pediatric patients, we identified 9993 children who underwent inguinal hernia repair between 2005 and 2014. We analyzed this cohort to determine the incidence of recurrence, time from initial repair to recurrence, and risk factors associated with hernia recurrence. We found an overall incidence of 3.46 events per 1000 person-years. When we stratified by age, those < 1y at initial repair had the highest incidence of recurrence, with 5.88 events per 1000
Conclusions
We described the incidence, timing, and risk factors for inguinal hernia recurrence using a large nationally representative cohort of children. Incidence rates were highest among children who underwent initial primary repair at < 1y. The majority of hernia recurrences occurred within the first year of initial repair, but occurred as late as 6y following initial repair. In multivariable analysis, hernia recurrence was most likely in younger children and children with multiple comorbidities.
References (22)
- et al.
Inguinal and umbilical hernia repair in infants and children
Surg Clin North Am
(1993) - et al.
Inguinal hernia in children: Factors affecting recurrence in 62 cases
J Pediatr Surg
(1991) - et al.
Surgical complications of inguinal and abdominal wall hernias
Semin Pediatr Surg
(2003) - et al.
Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review
J Pediatr Surg
(2006) - et al.
Risk factors for recurrence and contralateral inguinal hernia after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia
J Pediatr Surg
(2017) - et al.
Second hernia repairs in children - A nationwide study 2015
J Pediatr Surg
(2015) - et al.
Prematurity, not age at operation or incarceration, impacts complication rates of inguinal hernia repair
J Pediatr Surg
(2011) - et al.
Inguinal hernia repair in early infancy
Am J Surg
(1991) - et al.
Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary center
J Pediatr Surg
(2013) - et al.
Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair
J Pediatr Surg
(2005)
Incarceration of inguinal hernia in infants prior to elective repair
J Pediatr Surg
Cited by (38)
Optimal Timing of Inguinal Hernia Repair in Premature Infants: An NSQIP-P Study
2023, Journal of Surgical ResearchCosts and recurrence of inguinal hernia repair in premature infants during neonatal admission
2023, Journal of Pediatric SurgeryCitation Excerpt :Our results therefore suggest that hernias repaired in the post-NICU setting are generally more expensive, however, the follow up costs we suspect are associated with recurrences seen more frequently in early NICU repairs may offset the cost initially conserved with a NICU repair. In regard to hernia recurrence, our study demonstrates hernia recurrence rates in premature infants that are higher than reported in other studies that include older children [19]. Moreover, our data reinforces findings from a recent meta-analysis by Masoudian et al. [20], which showed that recurrences were more frequent in infants who had early IHR during initial NICU admission.
Open and laparoscopic inguinal hernia repair in children: A regional experience
2023, Journal of Pediatric SurgeryDelayed versus early repair of inguinal hernia in preterm infants: A systematic review and meta-analysis
2022, Journal of Pediatric SurgerySpigelian-like hernia with cryptorchidism and tibial hemimelia
2022, Journal of Pediatric Surgery Case ReportsFollow-up of children who undergo an uncomplicated surgical procedure: A caregiver survey to determine satisfaction, family impact, and preferences for alternate follow-up
2022, Journal of Pediatric SurgeryCitation Excerpt :Post-operative surgical follow-up has traditionally been carried out in-person to assess surgical sites and recovery. However, the rates of short-term hernia recurrence and wound infections are rare [1,2] and recovery is often straightforward. The Canadian healthcare system has been centralized since the 1990s to improve outcomes and to decrease costs to the healthcare system [3].
- ☆
Funding: This project was funded in part by the Henry M. Jackson Foundation for the Advancement of Military Medicine through a grant from the Department of Defense (DoD). WJ and AHH receive partial salary support.
- ☆☆
Role of the Funding Source: The funding source did not have a role in the collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication.
- ★
Disclaimer: The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.
- 1
Indicates co-first authors.