Hashmi Tallal Mushtaq, Ashraf Hadiah, Fatima Tehreem, Javed Amna, Kashif Muhammad Abdullah, Raza Soban, Ismail Khawaja Haris, Fatima Arooj, Iqbal Javed, Ahmed Raheel, Ahsan Areeba, Ahmed Mushood
Rawalpindi Medical University, Rawalpindi, Pakistan.
King Edward Medical University, Lahore, Pakistan.
World J Surg. 2025 Sep;49(9):2540-2548. doi: 10.1002/wjs.70014. Epub 2025 Jul 25.
Studies have shown conflicting findings regarding the optimal time for the repair of inguinal hernia in preterm infants. Our review aims to comprehensively synthesize the available evidence and provide robust, up-to-date insights into the clinical outcomes of delayed versus early repair of inguinal hernia in these patients.
A comprehensive search across PubMed, Cochrane Library, Clinicaltrials.gov, and Embase was conducted from inception until July 2024 to include RCTs and cohort studies comparing early versus delayed inguinal hernia repair. The odds ratios (ORs) were pooled along with corresponding 95% confidence intervals (CIs) for all clinical endpoints with the random effects model using RevMan 5.4.
Our meta-analysis pooled 10 studies involving 4253 preterm infants. The early hernia repair group had lower odds of developing incarceration (OR 0.43, 95% CI 0.34-0.54, p < 0.00001) but increased respiratory complications (OR 5.17, 95% CI 3.97-6.73, p < 0.00001) and recurrence rates (OR 3.25, 95% CI 1.18-8.92, p = 0.02) as compared to the delayed group. There were no statistically significant differences in testicular atrophy (OR 1.13, p = 0.91), iatrogenic ascending testis (OR 1.71, p = 0.61), postoperative hydrocele (OR 3.69, p = 0.21) or bowel injury (OR 1.16, p = 0.88) between early and delayed repair groups.
Timing of inguinal hernia repair requires balancing the risk of incarceration with anesthetic and recurrence concerns. Early hernia repair reduces incarceration but is associated with higher rates of respiratory complications and recurrence.
关于早产儿腹股沟疝修补的最佳时机，研究结果存在矛盾。我们的综述旨在全面综合现有证据，并就这些患者腹股沟疝延迟修补与早期修补的临床结局提供有力的最新见解。
从数据库建立至2024年7月，对PubMed、Cochrane图书馆、Clinicaltrials.gov和Embase进行全面检索，纳入比较早期与延迟腹股沟疝修补的随机对照试验（RCT）和队列研究。使用RevMan 5.4随机效应模型汇总所有临床终点的比值比（OR）及其相应的95%置信区间（CI）。
我们的荟萃分析纳入了10项研究，涉及4253例早产儿。与延迟修补组相比，早期疝修补组发生嵌顿的几率较低（OR 0.43，95%CI 0.34 - 0.54，p < 0.00001），但呼吸并发症（OR 5.17，95%CI 3.97 - 6.73，p < 0.00001）和复发率（OR 3.25，95%CI 1.18 - 8.92，p = 0.02）增加。早期和延迟修补组在睾丸萎缩（OR 1.13，p = 0.91）、医源性睾丸上升（OR 1.71，p = 0.61）、术后鞘膜积液（OR 3.69，p = 0.21）或肠损伤（OR 1.16，p = 0.88）方面无统计学显著差异。
腹股沟疝修补的时机需要在嵌顿风险与麻醉及复发问题之间进行权衡。早期疝修补可降低嵌顿风险，但与较高的呼吸并发症和复发率相关。
