Treatment of Routine Adolescent Inguinal Hernia Vastly Differs Between Pediatric Surgeons and General Surgeons

Nicholas E Bruns, MD¹, Ian C Glenn, MD¹, Neil L McNinch, MS, RN¹, Michael J Rosen, MD², Todd A Ponsky, MD¹. ¹Akron Children’s Hospital, ²Cleveland Clinic

Introduction: We hypothesize that for the same adolescent with an inguinal hernia, the treatment will differ between general surgeons and pediatric surgeons. We aimed to compare the preferences of adult and pediatric general surgeons in managing adolescents by conducting a survey through social media.

Methods: A poll was posted on the International Hernia Collaboration Group Facebook page as well as the Facebook page for the authoring pediatric surgeon. The poll gave scenarios of a 16-year-old male with an inguinal hernia and asked surgeons to select one of five listed procedures to repair the hernia: high ligation (open or laparoscopic), mesh repair (open or laparoscopic) or open muscle repair. The four scenarios differed in the diameter of the internal ring (1 cm vs. 4 cm) and the BMI of the patient (20 vs. 35). Fisher’s Exact Test was implemented for statistical analysis.

Results: In total, 43 (67%) adult surgeons and 21 (33%) pediatric surgeons responded. In the routine adolescent (normal BMI, small defect), 65% of adult surgeons chose adult-type repairs (mesh or muscle repairs) whereas 86% of pediatric surgeons chose pediatric-type repairs (high ligation). When the size of the defect increased, 100% of adult surgeons and 81% pediatric surgeons selected an adult-type repair, suggesting agreement. When the patient was obese, there was a tendency to prefer laparoscopy. In all patient scenarios, the answers were significantly different between pediatric and adult surgeons (p < 0.05).

Conclusions: For the same routine adolescent inguinal hernia, pediatric surgeons and adult general surgeons choose a different procedure. This finding suggests that further study is needed to determine the optimal treatment for inguinal hernias in adolescents, as the type of practitioner to whom the patient is referred, rather than the disease process itself, currently dictates treatment. 

Choice of repair for a routine adolescent inguinal hernia (small defect, normal BMI)

Repair type	Adult general surgeon	Pediatric surgeon
Open high ligation	23%	43%
Laparoscopic high ligation	12%	43%
Open mesh repair	12%	10%
Laparoscopic mesh repair	42%	0%
Open muscle repair	12%	5%