Meta-Analysis to Determine Optimal Timing for Repair of Inguinal Hernia in Pre-Term Infants.

Abstract

Studies have shown conflicting findings regarding the optimal time for the repair of inguinal hernia in preterm infants. Our review aims to comprehensively synthesize the available evidence and provide robust, up-to-date insights into the clinical outcomes of delayed versus early repair of inguinal hernia in these patients. A comprehensive search across PubMed, Cochrane Library, Clinicaltrials.gov, and Embase was conducted from inception until July 2024 to include RCTs and cohort studies comparing early versus delayed inguinal hernia repair. The odds ratios (ORs) were pooled along with corresponding 95% confidence intervals (CIs) for all clinical endpoints with the random effects model using RevMan 5.4. Our meta-analysis pooled 10 studies involving 4253 preterm infants. The early hernia repair group had lower odds of developing incarceration (OR 0.43, 95% CI 0.34-0.54, p < 0.00001) but increased respiratory complications (OR 5.17, 95% CI 3.97-6.73, p < 0.00001) and recurrence rates (OR 3.25, 95% CI 1.18-8.92, p = 0.02) as compared to the delayed group. There were no statistically significant differences in testicular atrophy (OR 1.13, p = 0.91), iatrogenic ascending testis (OR 1.71, p = 0.61), postoperative hydrocele (OR 3.69, p = 0.21) or bowel injury (OR 1.16, p = 0.88) between early and delayed repair groups. Timing of inguinal hernia repair requires balancing the risk of incarceration with anesthetic and recurrence concerns. Early hernia repair reduces incarceration but is associated with higher rates of respiratory complications and recurrence.