Risk of incarceration of inguinal hernias among paediatric patients awaiting elective surgery at the university teaching hospital, Lusaka, Zambia

Abstract

Inguinal hernias in infants and children are very common. One of their most common complications before surgery is incarceration, a life threatening condition with potential to cause severe short term and long term morbidities like bowel ischaemia, testicular atrophy and its resultant infertility, in future. There appears to be, institutional variability in the rates and risks of inguinal hernia incarceration among infants and children. This study was conducted with a purpose to determine our own institutional risk of inguinal hernia incarceration among infants and children awaiting elective surgery. A retrospective review of infants and children under the age of 17 years, who had undergone inguinal hernia repair or had incarcerated, from January 2015 to January 2017 was performed. Interviewer completed questionnaires were used to abstract data from the clinical records. Three hundred and sixty-four patients were included for analysis, in this study. Descriptive statistics, Pearson Correlation Coefficient, Regression Analysis and Kaplan Meiers Survival Analysis were used. The infants and children were stratified into seven age groups. The incarceration rates and risks were evaluated for each group. The overall incarceration rate was 13.45%. The risk of incarceration was age dependent. It ranged from 0.52 daily risk of incarceration, among neonates, to zero daily risk of incarceration among older children. Neonates were as high as five times more likely to incarcerate as older infants and children. Likewise, younger children had higher risk of inguinal hernia incarceration than older ones. Longer wait times were associated with increased rate and risk of inguinal hernia incarceration. Overall, risk reduction, of inguinal hernia incarceration, of more than 50% could be achieved if inguinal hernia repair was done within 14 days of diagnosis. This study concluded that, the rate of incarceration was high (13.45%). The risk of incarceration was age dependent & higher in neonates (0.52), infants & younger children (0.01). Neonates had as much as 5 times higher risk as other children. Longer wait times, male sex, right sided hernias were associated with higher rates & risks. Older children had no incarceration. The best time to operate is before 3 weeks for neonates, before 2 months for infants & before 4 months for younger children to prevent incarceration. Keywords: Infants and children, inguinal hernia, inguinal hernia incarceration, risk of hernia incarceration, incarceration rate, hernia repair, hernia surgery, wait time.