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Purpose <p>Laparoscopic and open approaches for unilateral inguinal hernia (UIH) repair in infants is considered equivalent; however, laparoscopy enables detection and closure of an open contralateral deep ring, potentially preventing metachronous hernia (MH). This study aimed to determine the incidence and risk factors of MH following open UIH surgery, assess contralateral ring status and complications from prophylactic closure, and analyse associated treatment costs.</p> Methods <p>A retrospective review was conducted of infants (&lt; 1&#xa0;year) who underwent UIH repair between 2016 and 2022. Children with bilateral or recurrent hernias or aged &gt; 1&#xa0;year were excluded. Data included surgical approach, contralateral ring findings, and MH incidence over a minimum 1-year follow-up. Risk factors analysed included sex, hernia side, corrected age, prematurity, chronic lung disease, and surgery urgency. Statistical analyses included chi-square and logistic regression. A cost comparison was performed between open and laparoscopic approaches.</p> Results <p>Of 715 infants (male: female ratio 8:1), 647 (91%) underwent open repair and 68 (9%) laparoscopic repair. MH developed in 8.5% (55/648) of open cases but none after laparoscopy. Prematurity (<i>p</i> &lt; 0.001) and emergency surgery (<i>p</i> = 0.003) were significant risk factors. An open contralateral ring was found and closed in 66% of laparoscopic cases without early complications. The number needed to treat (NNT) to prevent one MH was 13. Avoiding MH via initial laparoscopy could have saved £107,200 over 7 years.</p> Conclusions <p>MH incidence after open UIH repair is 8.5%, with higher risk in premature and emergency cases. Laparoscopy allows safe contralateral repair and offers both clinical and financial advantages.</p>

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Metachronous inguinal hernias in infants: incidence, risk factors and cost of treatment—a 7-year retrospective analysis from Northeast England

  • 期刊论文

  • 发表日期：

    2025年9月4日

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  • Vinayak Thattaruparambil,
  • Maheen Qazi,
  • Shivani Kuttuva,
  • Milan Gopal

摘要

Purpose

Laparoscopic and open approaches for unilateral inguinal hernia (UIH) repair in infants is considered equivalent; however, laparoscopy enables detection and closure of an open contralateral deep ring, potentially preventing metachronous hernia (MH). This study aimed to determine the incidence and risk factors of MH following open UIH surgery, assess contralateral ring status and complications from prophylactic closure, and analyse associated treatment costs.

Methods

A retrospective review was conducted of infants (< 1 year) who underwent UIH repair between 2016 and 2022. Children with bilateral or recurrent hernias or aged > 1 year were excluded. Data included surgical approach, contralateral ring findings, and MH incidence over a minimum 1-year follow-up. Risk factors analysed included sex, hernia side, corrected age, prematurity, chronic lung disease, and surgery urgency. Statistical analyses included chi-square and logistic regression. A cost comparison was performed between open and laparoscopic approaches.

Results

Of 715 infants (male: female ratio 8:1), 647 (91%) underwent open repair and 68 (9%) laparoscopic repair. MH developed in 8.5% (55/648) of open cases but none after laparoscopy. Prematurity (p < 0.001) and emergency surgery (p = 0.003) were significant risk factors. An open contralateral ring was found and closed in 66% of laparoscopic cases without early complications. The number needed to treat (NNT) to prevent one MH was 13. Avoiding MH via initial laparoscopy could have saved £107,200 over 7 years.

Conclusions

MH incidence after open UIH repair is 8.5%, with higher risk in premature and emergency cases. Laparoscopy allows safe contralateral repair and offers both clinical and financial advantages.