Evaluation of Mesh Placement in Adolescents Undergoing Inguinal Hernia Repair: A Multicenter Retrospective Cohort Study.

Abstract

Inguinal hernia repair (IHR) technique varies between children and adults, with adults commonly undergoing mesh placement. This study aimed to evaluate the incidence of mesh placement in adolescent patients (aged 12 to 17 years) who underwent IHR and to evaluate the incidence of hernia recurrence in relation to mesh placement. A retrospective chart review was conducted of pediatric patients who underwent initial IHR by pediatric surgeons at 20 US hospitals from 2017 to 2019. The primary outcomes were mesh placement and hernia recurrence. Demographic, operative, and postoperative factors were collected. Descriptive and inferential statistics were used to analyze the cohort, including bivariate analysis to identify factors associated with mesh placement and recurrence. A total of 708 adolescents were included in the analysis: 78.1% were male individuals with a median age of 15 years (interquartile range 13 to 16) and a median BMI of 20.6 kg/m 2 (interquartile range 18.2 to 23.4). Fifty-five patients (7.8%) had mesh placed during IHR. Of 708 adolescent patients, 9 (1.3%) had a documented hernia recurrence. On bivariate analysis, male sex, age, weight, and BMI were found to be significantly associated with mesh placement. Of patients who had mesh placed, 85% (47 of 55) underwent an open approach. All but 1 hernia recurrence occurred in the no-mesh group, although this did not reach statistical significance (p = 0.519). On binary regression analysis of mesh placement, increasing age and weight were associate with mesh placement. Few patients undergoing IHR by pediatric surgeons had mesh placed. Recurrence with a minimum 3-year follow-up was low at 1.3%, which may reflect that high ligation without mesh placement is adequate in adolescents.