Delay in Hernia Surgery Could Lead to Testicle and Ovary Damage

by Gopalan on Nov 6 2008 12:51 PM

Prolonged delay in hernia surgery for infants and toddlers could mean damage to testicles and ovaries. In Canada, though, the waiting time for children under two is twice longer than the recommended 14 days, researchers say.

Inguinal hernia is a bulge of tissue in the groin area and one of the most common surgical disorders of childhood. The hernia may be present at birth, causing vomiting, lack of bowel movements and other symptoms that send families to emergency rooms.

In Tuesday's issue of the Canadian Medical Association Journal, Dr. Jacob Langer of Toronto's Hospital for Sick Children and his colleagues reported that young children who waited more than 14 days for the surgical repairs showed a doubling of the risk of hernia incarceration — where a loop of bowel gets stuck in the opening of the abdominal wall in the groin area, also known as strangled hernia.

The loop starves the bowel of its blood supply, and the testicles or less commonly an ovary may slide down through a hernia and get stuck or damaged.

In the study, Langer and his colleagues looked at nearly 1,100 children under two in Ontario who had surgical repairs for inguinal hernias.

Among the children waiting for the elective surgery, 16.9 per cent were seen in an emergency department at least once and 11.9 per cent developed incarcerated hernias, which if left untreated, can cause serious health problems.

The rate of hernia incarceration was 5.2 per cent among babies who waited up to 14 days, compared with 10.1 per cent among those who waited up to 35 days, which was the median wait time from diagnosis to surgery.

"Our data support a recommendation that all inguinal hernias in infants and young children should be repaired within 14 days after surgical consultation," the study's authors concluded.

Children have largely been ignored in the debate on surgical wait times in Canada and babies with painful hernias have no political voice to demand resources, Dr. Geoffrey Blair, chair of the Pediatric Surgical Chiefs of Canada, said in a commentary accompanying the study.

"Our knee-jerk response might be simply to call for more operating room time, resources and personnel," Blair wrote in the commentary.

"However, there may be better solutions. For instance, infants and young children with an inguinal hernia could be appropriately stratified into urgent, less urgent and even 'wait-and-see' groups. This approach may offer a more effective strategy to manage the surgical needs of this population."

The risk to a boy's testes from incarceration are well known, even with surgical repair. But testicular damage after hernia repair may occur in up to 9.3 per cent of those operated on, Blair noted, in calling for a balance in making the repairs promptly against the risk of injuring an infant's delicate tissues during surgery.

In June, the federal government announced up to $9.8 million in funding for a Canada-wide project to manage pediatric wait times in 10 surgical areas, including cancer, cardiac, dental treatment, urology, gynecology and neurosurgery, CBC reported.