Older Children Undergoing Inguinal Hernia Repair Have Higher Recurrence Rates Than Younger Children and Adults: A Nationwide Cohort Study.

Abstract

Background: High ligation is the standard practice for inguinal hernia repair in children while adults undergo a floor repair. There is limited data to guide recommendations on the age at which floor repair should be considered. This is a hypothesis-generating study to understand the correlation of age and other factors with inguinal hernia recurrence in children.

Materials and methods: Children aged 6-17 years who underwent inguinal hernia repair by a pediatric surgeon between 2010 and 2022 were identified in the PearlDiver Mariner database, as were adults aged 18-25 years treated by an adult surgeon. Kaplan-Meier survival analysis and Cox proportional hazards modeling was used to determine the risk of hernia recurrence by age, sex, and obesity status.

Results: A total of 15,114 children and 20,863 adults were included. Children aged 16-17 years had a significantly increased five-year risk of hernia recurrence compared to children aged 6-10 years (2.5 % vs 0.8 %, adjusted hazard ratio [AHR]: 3.00, 95 % confidence interval [CI]: 1.98-4.56) as well as compared to the adult group (2.5 % vs 1.2 %, AHR 1.90, 95 % CI: 1.31-2.74). Obese males aged 14-17 years had the highest five-year rate of hernia recurrence of any group at 4.7 %.

Conclusions: Children 16-17 years of age who underwent inguinal hernia repair with pediatric surgeons have an increased risk of hernia recurrence compared to younger children as well as compared to adults treated by general surgeons. We hypothesize that high ligations, commonly performed by pediatric surgeons, may be inappropriate in some groups of older children.

Type of study: Cohort.

Level of evidence: Level III.