the predisposing factors in recurrenct inguinal hernias in ...€¦ · hernia. (j kor assoc pediatr...
TRANSCRIPT
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; [email protected]
* ~ ~~91 Jl.Al~ 2001\::1£ 1l~ 2~ Al%o1P'l 7B3:1'El ~l
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Table 1. Demographics of Recurred Patients
127
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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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rg (5.H%)0]S:!Jl., {l-~o] :lJ.5:l rj ~loH- 1,4'Wg (~.2%)0]
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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
pertropic pyloric stenosis
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