Pediatric Surgery International

, Volume 34, Issue 11, pp 1157–1161 | Cite as

Inguinal hernias in premature neonates: exploring optimal timing for repair

  • Faraz A. Khan
  • Nadine Zeidan
  • Shawn D. Larson
  • Janice A. Taylor
  • Saleem IslamEmail author
Original Article



Inguinal hernias have been reported in as many as 10–30% premature neonates, making inguinal herniorrhaphy (IHR) one of the most commonly performed surgical procedures. The timing of surgery remains controversial. The purpose of this report is to compare outcomes of IHR while in the NICU (inpatient) versus repair following discharge (outpatient) to determine optimal timing.


Premature neonates having undergone IHR over a 5-year period were identified and a retrospective case cohort analysis was performed.


263 patients underwent IHR during the 5-year study period with 115 (43.7%) having surgical repair inpatient (IP; prior to discharge) and 148 having outpatient herniorrhaphy (OP). Patients with IHR performed IP had significantly lower birth weight (p < 0.001), gestational age (p < 0.001), longer duration of surgery (p = 0.01) and were more likely to have post-operative ventilator dependence following repair; however, there were no differences in the rate of recurrence (p = 0.44) and incarceration (p = 0.45).


Our study demonstrated no significant differences in the rates of incarceration or recurrence, following in- or out-patient IHR. These findings suggest that IHR can potentially be offered as an outpatient procedure following hospital discharge in appropriate patients. The optimal timing of IHR in premature infants remains elusive and will likely require additional multicenter investigation.


Inguinal hernia Neonatal hernia repair Prematurity Hernia repair 



No external source of funding was utilized for this study.

Compliance with ethical standards

Conflict of interest

Authors have no relevant financial disclosures or conflicts of interest.

Ethical approval

This article is a retrospective chart review performed on deidentified patient data. Approval by the institutional IRB was obtained.

Informed consent

Informed consent was not applicable as this study is a retrospective chart review performed on deidentified patient data.


  1. 1.
    Coran AG, Adzick NS (2012) Pediatric Surgery, 1st edn. Elsevier Mosby, Philadelphia (print) Google Scholar
  2. 2.
    Bronsther B, Abrams MW, Elboim C (1972) Inguinal hernias in children—a study of 1,000 cases and a review of the literature. J Am Med Women’s Assoc 27(10):522Google Scholar
  3. 3.
    Harper RC, Garper A, Sia C (1975) Inguinal hernia: a common problem of premature infants weighing 1,000 grams or less at birth. Pediatrics 56(1):112–115PubMedGoogle Scholar
  4. 4.
    Kumar VH, Clive J, Rosenkrantz TS, Bourque MD, Hussain N (2002) Inguinal hernia in preterm infants (≤ 32-week gestation). Pediatr Surg Int 18(2):147–152CrossRefGoogle Scholar
  5. 5.
    Frumiento C, Abajian JC, Vane DW (2000) Spinal anesthesia for preterm infants undergoing inguinal hernia repair. Arch Surg 135(4):445–451CrossRefGoogle Scholar
  6. 6.
    Field DJ, Dorling JS, Manktelow BN, Draper ES (2008) Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5. Bmj 336(7655):1221–1223CrossRefGoogle Scholar
  7. 7.
    Steward DJ (1982) Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiol J Am Soc Anesthesiol 56(4):304–306Google Scholar
  8. 8.
    Turkyilmaz Z, Sonmez K, Karabulut R, Demirogullari B, Ozen IO, Kapisiz A, Kale N, Basaklar AC (2010) Incarcerated inguinal hernia in children. Hong Kong J Emerg Med 17(3):244CrossRefGoogle Scholar
  9. 9.
    Rowe MI, Clatworthy HW (1970) Incarcerated and strangulated hernias in children: a statistical study of high-risk factors. Arch Surg 101(2):136–139CrossRefGoogle Scholar
  10. 10.
    Puri P, Guiney EJ, O’Donnell B (1984) Inguinal hernia in infants: the fate of the testis following incarceration. J Pediatr Surg 19(1):44–46CrossRefGoogle Scholar
  11. 11.
    Uemura S, Woodward AA, Amerena R, Drew J (1991) Early repair of inguinal hernia in premature babies. Pediatr Surg Int 15(1):36–39CrossRefGoogle Scholar
  12. 12.
    Antonoff MB, Kreykes NS, Saltzman DA, Acton RD (2005) American Academy of pediatrics section on surgery hernia survey revisited. J Pediatr Surg 40(6):1009–1014CrossRefGoogle Scholar
  13. 13.
    Sulkowski JP, Cooper JN, Duggan EM, Balci O, Anandalwar SP, Blakely ML, Heiss K, Rangel S, Minneci PC, Deans KJ (2015) Does timing of neonatal inguinal hernia repair affect outcomes? J Pediatr Surg 50(1):171–176CrossRefGoogle Scholar
  14. 14.
    Wiener ES, Touloukian RJ, Rodgers BM, Grosfeld JL, Smith EI, Ziegler MM, Coran AG (1996) Hernia survey of the section on surgery of the American Academy of Pediatrics. J Pediatr Surg 31(8):1166–1169CrossRefGoogle Scholar
  15. 15.
    Andropoulos DB, Greene MF (2017) Anesthesia and developing brains—implications of the FDA warning. N Engl J Med 376:905–907CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Faraz A. Khan
    • 1
  • Nadine Zeidan
    • 1
  • Shawn D. Larson
    • 1
  • Janice A. Taylor
    • 1
  • Saleem Islam
    • 1
    Email author
  1. 1.Division of Pediatric Surgery, Department of SurgeryUniversity of Florida College of MedicineGainesvilleUSA

Personalised recommendations