Outcomes of herniotomy in premature infants: Recent 10 year experience

Background:  The timing of herniotomy in premature infants is controversial. Methods:  Outcomes of herniotomy in 47 premature infants admitted to the neonatal intensive care unit (NICU) were retrospectively reviewed for preoperative clinical features, respiratory interventions, and anesthetic and surgical complications. The data were compared with those of full-term infants (n= 52). Fourteen of the premature infants underwent herniotomy before NICU discharge and 33 after discharge. The predictive factors for anesthetic and surgical complications were also investigated via multiple regression analysis. Results:  Mean post-conceptional age at surgery in premature infants and full-term infants was 47 weeks and 50 weeks, respectively. Mean bodyweight at surgery in those infants was 4087 g and 5454 g, respectively. The rate of incarcerated hernia and emergency surgery was lower in premature infants. Delayed extubation of the tracheal tube after surgery was noted in four premature infants, but not in full-term infants. Two cases of cryptorchidism in premature infants and one recurrence in a full-term infant that required reoperation were noted. On multiple regression analysis no factor (including respiratory interventions) was found to be capable of predicting complications. Conclusion:  Although no predictive factor for complications was identified, there were some anesthetic and surgical complications in premature infants. If there is no risk of incarceration, herniotomy in premature infants should be performed at a time when the risk of anesthetic complications is decreased. If there is a risk of incarcerated hernia, herniotomy should be performed carefully in order to avoid occurrence of anesthetic and surgical complications.