What are the possible complications of pediatric hernias?

Updated: Oct 31, 2018
  • Author: Andre Hebra, MD; Chief Editor: Carmen Cuffari, MD  more...
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  • Few complications result from operative repair of an inguinal hernia. Possible consequences of hernia repair include decreased testicular size (≤ 20% of patients), testicular atrophy (1-2%), [16] vas injury (< 1%), and development of sperm-agglutinating antibodies. The risk of gonadal injury in females is low. Fortunately, in the hands of pediatric surgeons, such complications are quite rare.

  • The incidence of wound infection is 1-2%.

  • Hernia recurrence rates are around 1% when experienced pediatric surgeons perform the operation. Factors associated with recurrence of inguinal hernia include an unrecognized tear in the sac, failure to repair an enlarged inguinal ring, damage to the canal and inguinal floor, infection, history of incarceration, connective tissue disorder, and conditions producing increased intra-abdominal pressure (eg, chronic respiratory problems, constipation). The hernia recurrence rate with the laparoscopic technique has been reported to be higher if the surgeon is still in the "learning curve." However, in the hands of an experienced surgeon, the recurrence rate for the laparoscopic technique should be similar to the one reported for the open technique. 

    A study that included data from 9,993 pediatric patients who underwent inguinal hernia repair reported a recurrence rate of 1.4% with an incidence of recurrence 3.46 per 1000 person-years. The study also found that the majority of recurrence occurred within a year and children with multiple comorbidities had a greater risk of recurrence. [15]

  • The vas deferens and ilioinguinal nerve occasionally may be injured and should be repaired with 7-0 or 8-0 Maxon sutures. This may be technically difficult because of the extremely small vas lumen not traversed by semen. One infertility expert advises marking the ends of the vas with permanent suture and performing vasovasotomy after puberty with a 2-layer closure. It is also important to remember that the finding of vas or epididymis on the surgical pathology report does not necessarily imply injury because embryonal müllerian remnants have been recognized in 1-6% of surgical specimens. Specific histologic features of the remnant include a smaller diameter and failure to show a prominent muscular wall with Masson trichrome staining.

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