Surgical Management of Pediatric Inguinal Hernia: A Systematic Review and Guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee

Francesco Morini; Kelly M.A. Dreuning; Maarten J.H. Janssen Lok; Tomas Wester; Joep P.M. Derikx; Florian Friedmacher; Hiromu Miyake; Haitao Zhu; Luca Pio; Martin Lacher; Stefania Sgró; Augusto Zani; Simon Eaton; L.W. Ernest van Heurn; Agostino Pierro

doi:10.1055/s-0040-1721420

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2022; 32(03): 219-232
DOI: 10.1055/s-0040-1721420

Review Article

Surgical Management of Pediatric Inguinal Hernia: A Systematic Review and Guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee

Authors

Francesco Morini

¹Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, Instituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
Kelly M.A. Dreuning

²Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
Maarten J.H. Janssen Lok

³Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Tomas Wester

⁴Department of Pediatric Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
Joep P.M. Derikx

²Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
Florian Friedmacher

⁵Department of Pediatric Surgery, The Royal London Hospital, London, United Kingdom

⁶Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
Hiromu Miyake

⁷Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
Haitao Zhu

³Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

⁸Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
Luca Pio

⁹Department of Pediatric Surgery and Urology, Hôpital Universitaire Robert-Debré, University of Paris, Paris, France
Martin Lacher

¹⁰Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
Stefania Sgró

¹¹Department of Anesthesiology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
Augusto Zani

³Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

¹²Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Simon Eaton

¹³Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
L.W. Ernest van Heurn

²Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
Agostino Pierro

³Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Abstract

Introduction Inguinal hernia repair represents the most common operation in childhood; however, consensus about the optimal management is lacking. Hence, recommendations for clinical practice are needed. This study assesses the available evidence and compiles recommendations on pediatric inguinal hernia.

Materials and Methods The European Pediatric Surgeons' Association Evidence and Guideline Committee addressed six questions on pediatric inguinal hernia repair with the following topics: (1) open versus laparoscopic repair, (2) extraperitoneal versus transperitoneal repair, (3) contralateral exploration, (4) surgical timing, (5) anesthesia technique in preterm infants, and (6) operation urgency in girls with irreducible ovarian hernia. Systematic literature searches were performed using PubMed, MEDLINE, Embase (Ovid), and The Cochrane Library. Reviews and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement.

Results Seventy-two out of 5,173 articles were included, 27 in the meta-analyses. Laparoscopic repair shortens bilateral operation time compared with open repair. In preterm infants, hernia repair after neonatal intensive care unit (NICU)/hospital discharge is associated with less respiratory difficulties and recurrences, regional anesthesia is associated with a decrease of postoperative apnea and pain. The review regarding operation urgency for irreducible ovarian hernia gained insufficient evidence of low quality.

Conclusion Laparoscopic repair may be beneficial for children with bilateral hernia and preterm infants may benefit using regional anesthesia and postponing surgery. However, no definite superiority was found and available evidence was of moderate-to-low quality. Evidence for other topics was less conclusive. For the optimal management of inguinal hernia repair, a tailored approach is recommended taking into account the local facilities, resources, and expertise of the medical team involved.

Keywords

hernia - inguinal - laparoscopy - anesthesia - general - child - ovary

Full Text

References

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