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.
ASJC Scopus subject areas