Risk of incarceration in children with inguinal hernia: a systematic review
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Surgical repair is recommended for all children with inguinal hernia due to fear of incarceration. The aim of this study was to assess the risk of incarceration and strangulation of inguinal hernias in children treated with delayed surgery or no surgery.
Systematic searches were conducted in three databases. We included studies reporting on children with inguinal hernia, with the majority ≤ 10 years old. The interventions were non-acute inguinal hernia surgery or no surgery. The main outcomes were incarceration and strangulation. Secondary outcomes were postoperative complications. Randomized controlled trials, non-randomized controlled trials, and observational studies were included.
We included 22 studies with 14,959 children. All studies reported on elective repairs. None of the studies specifically reported on watchful waiting. Of the studies reporting wait time as mean or median, the median wait time was 46 days (range 1–552). The crude incarceration rate across the included studies was 7% for all children and 11% for preterm children. The testicular atrophy rate was 1% and the recurrence rate was 1%.
The risk of incarceration in children awaiting inguinal hernia surgery is substantial. In general, we cannot support delaying surgery unnecessarily. However, there may be benefits of delaying surgery in individual cases. In such cases, the surgeon should assess if the benefits may overrule the risk of incarceration.
KeywordsInguinal hernia Children Elective surgery Delayed repair Incarceration Watchful waiting
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study received no financial support from extramural sources.
Compliance with ethical standards
Conflict of interest
Olesen reports no potential conflicts of interest. Mortensen reports no potential conflicts of interest. Öberg reports no potential conflicts of interest. Rosenberg reports personal fees from Bard and Merck, outside the submitted work.
This kind of study does not need ethical approval.
Human and animal rights
This article does not contain any studies directly involving human participants, as it is a review of data already collected in a hernia database.
For this type of study informed consent was not required.
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