I was would like to know what most practice in regard to timing of inguinal hernia repair on preemies. I have found this question sometimes difficult to answer given the magnitude of implications which I would like to mention and get your opinion on:

1- Preemies are at higher risk to develop acute surgical complications from a inguinal hernia compared to older infants, but I've never seen one occur in over 7 years of NICU experience, have you?

2- Some consider the repair of an inguinal hernia a relative surgical emergency because of the above, do you?

3- Most inguinal hernias in preemies will be repaired before the infant is discharge home from the NICU, do you do this?

4- Most inguinal hernia repair in preemies will require elective intubation and general anesthesia, but local anesthesia with mild sedation is possible, what do you do on your unit?

5- A large number of preemies with inguinal hernia also has CLD and intubating them for a preventive surgery seems to be inappropriate given a possible major respiratory set back, so waiting for 6 months to a year before repair seems reasonable, what do you think about this?

Thanks

we do inguinal hernia repair for preemies before discharge, and our ped. surgeons would like the infant's weight 2 kg or more before the repair, and usually the surgery done under GA.

My comments are...

1- Preemies are at higher risk to develop acute surgical complications from a inguinal hernia compared to older infants, but I've never seen one occur in over 7 years of NICU experience, have you?

I have not seen any serious complications either. According to my experience - pain, slight feeding intolerance are not uncommon, but complications leading to extra days in hospital, I cannot remember one over 10 years.

2- Some consider the repair of an inguinal hernia a relative surgical emergency because of the above, do you?

No. In my world, this is elective surgery and should be planned accordingly (minimize risk-taking).

3- Most inguinal hernias in preemies will be repaired before the infant is discharge home from the NICU, do you do this?

Yes!

4- Most inguinal hernia repair in preemies will require elective intubation and general anesthesia, but local anesthesia with mild sedation is possible, what do you do on your unit?

At the Karolinska univ hospital:

- if open surgery - generally sedation and laryngeal mask, and sacral epidural analgesia

- if laparoscopic surgery - general anestesia

5- A large number of preemies with inguinal hernia also has CLD and intubating them for a preventive surgery seems to be inappropriate given a possible major respiratory set back, so waiting for 6 months to a year before repair seems reasonable, what do you think about this?

As most hernias cause relatively little problems, I personally agree. In these few really severe BPD ex-premies (on CPAP/O2 for many-many weeks etc) we would in most cases try to postpone surgery as long as possible, to reduce the risk of intubation/weaning from mechanical ventilation post-surgery.