Hernias and hydroceles

Abstract

The primary reason to operate on hernias is to prevent bowel incarceration. Secondary aims of surgery: 1. Avoid recurrent hernia. 2. Decrease metachronous hernia. 3. Treat bother associated with the hernia. Summary of evidence for these aims: Incarceration was reported by one case series in 12 % of patients, decreasing with age from 39 % in preterm neonates to 6 % in teenagers. Bowel resection for necrosis is rare, occurring in <1 % of incarcerated hernias. One prospective longitudinal study reported 84 % of newborn communicating hydroceles resolved by 18 months of age. Two studies reported 0 and 5 % of communicating hydroceles observed in children <2 years of age developed hernias, none with incarceration. Recurrent hernia occurs in ≤4 %, with meta-analysis finding no difference in open versus laparoscopic repair. Meta-analysis of unilateral open repair found metachronous hernia in 7 %, not predicted by age <2 years versus older, or gender, although left hernias had higher risk. Meta-analysis of laparoscopic versus open repair reported significant reduction in metachronous hernia with laparoscopic surgery. Our review found no data regarding bother of untreated hydroceles or hernias in children.