Endosurgical treatment of premature infants with inguinal hernias

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Introduction. An inguinal hernia is a serious surgical issue in premature infants as this is one of the reasons leading to increased lethality and longer treatment duration. The purpose of the study was to estimate the possibility and effectiveness of endosurgical treatment of inguinal hernias in premature infants.

Material and methods. 705 patients with inguinal hernias aged 0–3 months have been treated at the Center for Surgery of Newborns in Irkutsk during the last 15 years from January 2004 to December 2018. The gestational age of 51 infants was less than 37 weeks. All the patients underwent laparoscopic hernia repair with extracorporeal ligation. During the final stage of the study, demographic data, intra- and postoperative results were compared.

Results. The experience of treating 51 premature infants with inguinal hernias was analyzed. The children were distributed into groups as follows: 1,500–2,500 g for 35 patients, 1,000–1,500 g for 14 patients, less than 1,000 g for 2 patients. The average weight and age was 1,870 g/36.9 days for children with low body weight, 1148.3 g/48.9 days for children with very low body weight and 810 g/69 days for children with extremely low body weight. The average surgery duration ranged from 28.8 min to 35 min. According to the results of the study, increased gestational age and body weight decreases the risk of postoperative apnea from 100% to 11.8%.

Conclusion. It must be noted that minimally invasive surgeries are less traumatic and effective interventions when treating premature infants with inguinal hernias. In infants with premature hernias, a surgery is always associated with the risk of postoperative apnea and AVL dependent on the body weight and gestational age.

About the authors

Yury A. Kozlov

Irkutsk Municipal Pediatric Clinical Hospital; Irkutsk State Medical Academy of Continuing Education; Irkutsk State Medical University Russia

Author for correspondence.
Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X

Dr. Sci.(Med), head of department of neonatal surgery at Irkutsk Municipal Pediatric Clinical Hospital; professor of the department of pediatric surgery at Irkutsk State Medical University Russia; professor of the department of pediatric surgery at Irkutsk State Medical Academy of Continuing Education

Sovetskaya 57, Irkutsk, Russia, 664009; phone: +7(914)009-44-67

Russian Federation

Pavel A. Krasnov

Irkutsk Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
Russian Federation

Polina J. Baradieva

Irkutsk Municipal Pediatric Clinical Hospital

Email: p.baradieva@icloud.com
ORCID iD: 0000-0002-5463-6763

Pedaitric surgeon at Irkutsk Municipal Pediatric Clinical Hospital

Sovetskaya 57, Irkutsk, Russia, 664009; phone: +7(950)105-04-31

Russian Federation

Denis A. Zvonkov

Irkutsk Municipal Pediatric Clinical Hospital

Email: Denis.Zvonkov@mail.ru
ORCID iD: 0000-0002-7167-2520

Pedaitric surgeon at Irkutsk Municipal Pediatric Clinical Hospital

Sovetskaya 57, Irkutsk, Russia, 664009; phone: +7(950)069-17-47

Russian Federation

Chimit B. Ochirov

Irkutsk Municipal Pediatric Clinical Hospital

Email: chimitbator@gmail.com
ORCID iD: 0000-0002-6045-1087

Surgeon of department of neonatal surgery at Irkutsk Municipal Pediatric Clinical Hospital

Sovetskaya 57, Irkutsk, Russia, 664009; phone: +7(983)241-73-33

Russian Federation


  1. Gross R. E. The surgery of infancy and childhood.Philadelphia: Saunders; 1953: 449-66.
  2. Bronsther B., Abrams M. W., Elboim C. Inguinal hernia in children - a study of 1000 cases and a review of the literature. J. Am. Ed. Wom. Assoc. 1972; 27:524.
  3. Holder T. M., Ashcraft K. W. Groin hernias and hydroceles. In: Textbook of Pediatric Surgery, Saunders, Philadelphia. 1980:594-608.
  4. Grosfeld J. L. Groin IH in infants and children. In: Nyhus L. M., Condon R. E. (eds) Hernia, Lippincott, Philadelphia, 1989:81-96.
  5. Harper R. G., Garcia A., Sia C. Inguinal hernia: a common problem of premature infants weighing 1000g or less at birth. Pediatrics 1975; 56:112.
  6. Kumar V., Clive J., Rosenkrantz T., Bourque M., Hussain N. Inguinal hernia in preterm infants (< or = 32-week gestation). Pediatr. Surg. Int. 2002;18:147-152. doi: 10.1007/s003830100631
  7. Nelson W. E., Vaughan V. C., McKay R. J. Textbook of pediatrics. Philadelphia: W. B. Saunders; 1979;12:1107.
  8. Peevy K. J., Speed F. A., Hoff C. J. Epidemiology of inguinal hernia in preterm neonates. Pediatrics 1986; (77): 246-24.
  9. Misra D. Inguinal hernias in premature babies: wait or operate? Acta Paediatr. 2001; 90: 370-1. doi: 10.1111/j.1651-2227.2001.tb00433.x
  10. Brandt M. L. Pediatric Hernias. Surg. Clin. North Am. 2008; 88:27-43. doi: 10.1016/j.suc.2007.11.006
  11. Youn J. K., Kim H. Y., Huh Y. J., Han J. W., Kim S. H., Oh C., Jo A. H., Park K. W., Jung S. E. Inguinal hernia in preterms in neonatal intensive care units: Optimal timing of herniorrhaphy and necessity of contralateral exploration in unilateral presentation. J. Pediatr. Surg. 2018 Feb 24. pii: S0022-3468(18)30119-2. doi: 10.1016/j.jpedsurg.2018.02.056
  12. Долецкий С. Я. Ущемленные паховые грыжи у детей. Москва: Медгиз, 1952:158
  13. Щебеньков М. В., Баиров В. Г., Алейников Я. Н. Эндовидеохирургическое лечение детей с патологией влагалищного отростка брюшины, СПб. 2001: 6-10.
  14. Исаков Ю. Ф., Дронов А. Ф. Ущемленная паховая грыжа. В кн. Детская хирургия: национальное руководство - М. 2007. - С690.
  15. Игнатьев Р. О. Принцип минимальной травматичности в выборе метода эндохирургического лечения детей с паховыми грыжами. Российский Вестник детской хирургии, анестезиологии и реаниматологии. 2012; 2(1): 49-55.
  16. Дронов А. Ф., Козлов Ю. А., Мокрушина О. Г., Морозов Д. А., Новожилов В. А., Петлах В. И., Поддубный И. В., Разумовский А. Ю., Розинов В. М., Соколов Ю. Ю., Стальмахович В. Н., Щебеньков М. В. Ущемленные паховые грыжи у детей. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2013; 3(3): 87-96.
  17. Стальмахович В. Н. Паховые грыжи у детей. Иркутск 2014. ГУ НЦ РВХ ВСНЦ СО РАМН, 2007 - С. 204.
  18. Lobe T. Two year experience with minimally invasive hernioraphy in children. Surgical endoscopy. 2005; 19:551-3. doi: 10.1007/s00464-004-8922-x
  19. Schier F. Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J. Pediatr. Surg. 2006;41:1081-4. doi: 10.1016/j.jpedsurg.2006.02.028
  20. Shalaby R. Y, Fawy M., Soliman S. M., Dorgham A. A new simplified technique for needlescopic inguinal herniorrhaphy in children. J. Pediatr. Surg.2006; 41:863-7. doi: 10.1016/j.jpedsurg.2005.12.042
  21. Takehara H., Yakabe S., Kameoka K. Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions. J. Pediatr. Surg. 2006; 41: 1999-2003. doi: 10.1016/j.jpedsurg.2006.08.032
  22. Endo M., Watanabe T., Nakano M., Yoshida F., Ukiyama E. Laparoscopic completely extraperitoneal repair of inguinal hernia in children: a single-institute experience with 1,257 repairs compared with cut-down herniorrhaphy. Surg. Endosc. 2009; 23:1706-12 doi: 10.1007/s00464-008-0300-7
  23. Montupet P., Esposito C. Fifteen years experience in laparoscopic inguinal hernia repair in pediatric patient. Result and consideration on a debated procedure. Surg. Endoscop. 2011; 25: 450-3. doi: 10.1007/s00464-010-1188-6
  24. Takehara H., Hanaoka J., Arakawa Y. Laparoscopic strategy for inguinal ovarian hernias in children: when to operate for irreducible ovary. J. Laparoendosc. Adv. Surg. Tech. A. 2009 Apr;19 Suppl 1: S129-31. doi: 10.1089/lap.2008.0204.supp
  25. Burge D. M., Sugarman I. S. Exclusion of androgen insensitivity syndrome in girls with inguinal hernias: current surgical practice. Pediatr. Surg. Int. 2002; 18: 701-3. doi: 10.1007/s00383-002-0801-8
  26. Osifo O. D., Ovueni M. E. Inguinal hernia in Nigerian female children: beware of ovary and fallopian tube as contents. Hernia 2009; 13: 149-53. doi: 10.1007/s10029-008-0446-1
  27. Boley S. J., Cahn D., Lauer T., Weinberg G., Kleinhaus S. The irreducible ovary: a true emergency. J. Pediatr. Surg. 1991; 26:1035-8.
  28. Grosfeld J. L., Minnick K., Shedd F., West K. W., Rescorla F. J., Vane D. W. Inguinal hernia in children: factors affecting recurrence in 62 cases. J. Pediatr. Surg. 1991; 26: 283-7.
  29. Walsh S. J. The incidence of external hernias in premature infants. Act. Pediatr. 1962; 51:161.
  30. Boocock B., Todd P. J. Inguinal hernias are common in preterm infants. Arch. Dis. Child. 1985; 60: 669.
  31. Rajput A., Gauderer M. W. L, Hack M. Inguinal hernias in very low birth weight infants: incidence and timing of repair. J. Pediatr. Surg. 1992; 27:1322.
  32. Janik J. S., Shandling B. The vulnerability of the vas deferens (II): the case against routine bilateral inguinal exploration. J. Pediatr. Surg. 1982; 17:585-8.
  33. Uemera S., Woodward A. A., Amerena R., Drew J. Early repair of inguinal hernia in premature babies. Pediatr. Surg. Int. 1999; 15:36-9. doi: 10.1007/s003830050507
  34. Gonzalez Santacruz M., Mira Navarro J., Encinas Goenechea A., García Ceballos A., Sánchez Zaplana H., Jiménez Cobo B. Low prevalence of complications of delayed herniotomy in the extremely premature infant. Acta. Paediatr. 2004; 93:94-8.
  35. Walther - Larsen S., Rasmussen L. S. The former preterm infant and risk of postoperative apnoea: recommendations for management. Act. Anaesthesiol. Scand. 2006; 50:888-93. doi: 10.1111/j.1399-6576.2006.01068.x
  36. Murphy J. J., Swanson T., Ansermino M., Milner R. The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit? J. Pediatr. Surg. 2008; 43:865-8. doi: 10.1016/j.jpedsurg.2007.12.028
  37. Щебеньков М. В. Лапароскопическая герниорафия. Эндоскопическая хирургия. 1995; 4: 7-9.
  38. El-Gohary M. A. Laparoscopic ligation of inguinal hernia in girls. Pediatr. Endosurg. Innov. Techn. 1997; 1:185-187. doi: 10.1089/pei.1997.1.185
  39. Montupet P., Esposito C. Laparoscopic treatment of congenital inguinal hernia in children. J. Pediatr. Surg. 1999; 34:420-3.
  40. Ozgediz D., Roayaie K., Lee H., Nobuhara K. K., Farmer D. L., Bratton B., Harrison M. R. Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: report of a new technique and early results. Surg. Endosc. 2007; 21:1327-1331. doi: 10.1007/s00464-007-9202-3
  41. Stylianos S., Jacir N. N., Harris B. H. Incarceration of inguinal hernia in infants prior to elective repair. J. Pediatr. Surg. 1993; 28: 582-3.
  42. Steinau G., Treutner K. H., Feeken G., Schumpelick V. Recurrent inguinal hernias in infants and children. World J. Surg. 1995;19:303-6. doi: 10.1007/bf00308645
  43. Ein S. H., Njere I., Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J. Pediatr. Surg. 2006; 41: 980-6. doi: 10.1016/j.jpedsurg.2006.01.020
  44. Schier F. Laparoscopic surgery of inguinal hernias in children: initial experience. J. Pediatr. Surg. 2000; 35:1331-5. doi: 10.1053/jpsu.2000.9326
  45. Antonoff M. B., Kreykes N. S., Saltzman D. A., Acton R. D. American Academy of Pediatrics section on surgery hernia survey revisited. J. Pediatr. Surg. 2005; 40: 1009-14. doi: 10.1016/j.jpedsurg.2005.03.018
  46. Steward D. J. Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiology. 1982; 56: 304-6.
  47. Davidson A. J., Morton N. S., Arnup S. J., de Graaff J. C., Disma N., Withington D. E., Frawley G., Hunt R. W., Hardy P., Khotcholava M., von Ungern Sternberg B. S., Wilton N., Tuo P., Salvo I., Ormond G., Stargatt R., Locatelli B. G., McCann M. E. General Anesthesia compared to Spinal anesthesia (GAS) Consortium. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study - Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial. Anesthesiology. 2015; 123: 38-54. doi: 10.1097/ALN.0000000000000709
  48. Kurth C. D., Spitzer A. R., Broennle A. M., Downes J. J. Postoperative apnea in preterm infants. Anesthesiology. 1987; 66: 483-8. doi: 10.1097/00000542-198704000-00006

Copyright (c) 2019 Kozlov Y.A., Krasnov P.A., Baradieva P.J., Zvonkov D.A., Ochirov C.B.

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