Abstract
The primary reason to operate on hernias is to prevent bowel incarceration.
Secondary aims of surgery:
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1.
Avoid recurrent hernia.
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2.
Decrease metachronous hernia.
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3.
Treat bother associated with the hernia.
Summary of evidence for these aims:
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Incarceration was reported by one case series in 12 % of patients, decreasing with age from 39 % in preterm neonates to 6 % in teenagers.
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Bowel resection for necrosis is rare, occurring in <1 % of incarcerated hernias.
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One prospective longitudinal study reported 84 % of newborn communicating hydroceles resolved by 18 months of age.
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Two studies reported 0 and 5 % of communicating hydroceles observed in children <2 years of age developed hernias, none with incarceration.
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Recurrent hernia occurs in ≤4 %, with meta-analysis finding no difference in open versus laparoscopic repair.
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Meta-analysis of unilateral open repair found metachronous hernia in 7 %, not predicted by age <2 years versus older, or gender, although left hernias had higher risk.
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Meta-analysis of laparoscopic versus open repair reported significant reduction in metachronous hernia with laparoscopic surgery.
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Our review found no data regarding bother of untreated hydroceles or hernias in children.
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Jacobs, M.A. (2013). Hernias and Hydroceles. In: Snodgrass, W. (eds) Pediatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6910-0_6
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