Predictors of recurrence after inguinal herniotomy in boys

Recurrence is the most important complication of inguinal hernia repair in childhood, but little is known about its contributing factors. The aim of our study was to identify factors evident at the time of primary surgery that may be predictive of subsequent recurrence. All hernias in boys operated on by the Christchurch-based Paediatric Surgical Service of the South Island of New Zealand between September 1996 and December 2007 were reviewed. Characteristics of initial hernias that recurred were compared with hernias that did not recur. There were 2,471 primary herniotomies in boys, of which 17 recurred, giving an overall recurrence rate of 0.69%. Factors predicting an increased likelihood of later recurrence were inadvertent opening of the hernial sac during its dissection off the vas and vessels (OR = 5.1, P = 0.0039) and larger size of the hernia (P = 0.0037). Ten recurrences (62.5%) occurred in infants less than 37 weeks gestation. Hernias considered 'massive' at the time of surgery tended to recur earlier (P = 0.006), as did those where the sac was opened (P = 0.011). The side of the hernia and initial strangulation did not differ significantly between the two groups. Larger hernial sacs and sacs inadvertently opened during surgery are predictors of later recurrence. Low gestation and specific comorbidities were also associated with a higher likelihood of recurrence.