126 5:o}~l:iI} : All 81'! All 2 ~ 2002\1 Vol. 8. No.2. December 2002

The Predisposing Factors in Recurrenct Inguinal Hernias in Infants

and Children

Jae-Tae Doh, M.D., Byun Young Kim, M.D., Seung Eun Choi, M.D.,

Sung-Eun Jung, M.D., Seong-Cheol Lee, M.D., Kwi-Won Park, M.D., Woo-Ki Kim, M.D.

Department of Pediatric Surgery, Seoul National University College of Medicine

Seoul, Korea

Inguinal hernia is a major surgical disease in pediatric surgery, occurring in 3.5% to 5% of

all mature newborns and 9% to 11% of all premature babies. The objective of this study is to analyze the predisposing factors in association with recurrences of inguinal hernias in infants and children. In the period from January 1995 to September 2001, 1,575 infants and

children who had primary inguinal hernias or recurrent inguinal hernias operated on at the Department of Pediatric Surgery at Seoul National University Hospital were evaluated retrospectively. We evaluated the data by medical records and by telephone interview. The

sex, age, location of hernia, comorbidity, prematurity, incarceration, interval to operation after incarceration, postoperative complications were analyzed as predisposing factors in associated with hernia recurrence. Operative findings of recurrent inguinal hernia were

reviewed. The data were statistically analyzed with Pearson Chi-Square test and Fisher-exact test. A total of eighteen 0.14%) out of 1,575 patients underwent an operation due to recurrent inguinal hernia. In 5 (27.8%) out of 18 recurred patients, institution of the

primary herniorrhaphy was our hospital and in the other 13 (72.2%) was outside hospital. No impact on the development of recurrences was seen for sex, age, interval to operation after incarceration, and postoperative complications. The significant predisposing factors of

recurrent inguinal hernias were left inguinal hernias (p=0.002), comorbidity (p=0.002), prematurity (p=0.006), incarceration (p=0.017) and technical error of first herniorrhaphy.

We expect that knowledge for predisposing factors of recurrent inguinal hernias and experienced skill of pediatric surgeons will decrease recurrence rate in primary inguinal hernia. (J Kor Assoc Pediatr Surg 8(2):126-132), 2002.

Index Words: Inguinal hernia, Recurrent, Predisposing factors

Correspondence : Kwi Won Park, MD., Department of Ped­iatric Surgery, Seoul National University Childern's Hospital, 28 yeonkun-dong, Chongno-gu, Seoul 110-744, Korea Tel; 760-3635, Fax; 766-3975, E-mail; pedsurg@plaza.snu.ac.kr

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Table 1. Demographics of Recurred Patients

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Case Sex Age at Age at

Site 1st Op. Reop. Comorbidity Prematurity Incarceration Postop.

complication Op. Finding Op 1st op

M 16m 2yr BIH FSL HL OH

2 M 4m 16m BIH + + LL HL OH

3 M 12d 12d LlH neurofibroatosis FSL HL SUNH

4 M 2yr 9yr LlH FSL HL OH

5 M 3yr 6yr LlH + LL HL OH

6 M 15m 19m LlH FSL HL OH

7 M 2yr 6yr LlH LL HL OH

8 M 7yr 9yr LlH + LL HL OH

9 M 2m 4m LlH congenital hypothyroidsm

DPT mesh SUNH +

10 M 3m 3m LlH + FSL HL SUNH

11 M 13yr 14yr LlH LL HL OH

12 M 10yr 11yr LlH omphalocele LL HL OH

13 M 7yr 11 yr LlH LL HL OH

14 M 3m 5m LlH ROP + LL HL SUNH

15 M 1yr 4yr RIH LL HL SUNH

16 M 1 yr 2yr RIH TOF LL HL OH

14 M 2m 2m RIH FSL HL OH

18 M 2yr 3yr RIH + + FSL HL OH

Abbreviations: ROP; retinopathy of prematurity, TOF; tetralogy of Faliot, FSL; false sac ligated, LL; low ligated, DPT; dorsal peritoneum teared, HL; high ligated, OH: other hospital, SNUH; Seoul National University Hospital

128

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129

Table 2. Predisposing Factors in Association with Recurrent Inguinal Hernia

No. of patient No. of recurrence (%) p-value

Sex

male

female

Age of 15t operation

< 1m

::-1m

< 1yr

::-1yr

Location

RIH

LlH

Comorbidity (+)

( - )

Prematurity (+)

( - )

Incarceration (+)

( - )

Interval to operation after incarceration

< 48hr

::-48hr

P05tOp. complication

Fisher-exact analysis

( + )

( - )

1,264

311

5

1,570

374

1,201

1,136

979

88

1,487

109

1,466

91

1,484

8

83

10

1,565

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fj-§f<l ~!lj

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0(0%)

1(20%)

17(1.08%)

5(1.1%)

13(1.3%)

6(0.5%)

14(1.4%)

5(5.7%)

13(0.9%)

5(4.6%)

13(0.9%)

4(4.4%)

14(0.9%)

0(0%)

4(4.8%)

0(0%)

18(1.2%)

0.044'

0.056

0.068

0.002

0.002

0.006

0.017

0.000'

0.897'

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1.30

Table 3. Cormorbid Disease

Congenital heart disease(ASD, VSD, CoA, TOF, TGA et al)

VP shunt

Pulmonary

TEF

lung agenesis

Gastrointestinal

Hirschsprung's disease

HPS

biliary atresia

imperiorate anus

Meckel's diverticulum

jejunal atresia

intestinal lymphangiectasia

Genitourinary

undescended testis

hypospadia

ureteropylelo junction obstruction

vesicoureterak reflux

concealed penis

Others

chronic renal failure

omphalocele

tongue tie

umbilical hernia

cleft palate

congenital hypothyrodism

Wilson's disease

Williams's syndrome

neurofibromatosis

funnel chest

glycogen storage disease

Total

No. of cases

28

9

2

7

5

4

3

21

5

6

5

2

3

2

1

2

2

112

Abbreviations: ASD; atrial septal defect, VSD; ventricular septal defect, eOA; coarctation of aDria, TOF; tetralogy of Fallat, TGA; transposition of the great arteries, HPS; hy­

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