In my previous blogs and YouTube videos, I provided very detailed information about inguinal hernias in children. I drew diagrams to explain why they occur and discussed when and how they should be treated. However, since this is such a common issue, the questions I receive never seem to stop.
In The Pediatric Surgeon’s Journal, I’d like to briefly talk about the possibility of recurrence after inguinal hernia surgery in children. Let’s begin.
First, to answer the question in the title: Yes, an inguinal hernia can recur after surgery.
While the recurrence rate is generally considered to be around 1%, in some cases, it can go up to 24%. These higher rates are seen in conditions that increase abdominal pressure, such as ventriculoperitoneal shunts, cystic fibrosis, ascites, malnutrition, prematurity, undescended testicles, connective tissue disorders, and incarcerated hernias.
Let me summarize findings from some studies for you:
One study followed approximately 10,000 children who underwent hernia surgery for an average of 3.5 years and found a recurrence rate of 1.4%. Most of these recurrences—about 60%—occurred in children who were operated on during their first year of life, and the majority happened within the first year after surgery.
To summarize, children operated on during their first year of life are 2.5 times more likely to experience recurrence, and those with multiple health conditions are 5.4 times more likely.
In another study involving the laparoscopic hernia repair technique I discussed in earlier videos (where the internal inguinal ring is closed using a needle inserted through the skin), the recurrence rate over a 3-year follow-up of 714 children was about 1%. This technique, known as PIRS (Percutaneous Internal Ring Suturing), is reported to be safe and effective with such low rates.
According to the 2022 publication by the Evidence and Guidelines Committee of the European Paediatric Surgeons’ Association, the laparoscopic method is especially beneficial in bilateral hernias, with low recurrence and complication rates.
However, despite this report, a follow-up of over 8,000 children who underwent bilateral hernia surgery showed a recurrence rate of 1.5% for open surgery and 2.8% for laparoscopic surgery within the first year.
I know I’ve mentioned a lot of numbers. To quickly summarize:
  • In unilateral hernia surgeries, the risk of developing a hernia on the opposite side later is between 6% and 12%.
  • Overall, even in the most experienced hands, the recurrence rate after hernia surgery ranges between 1% and 3%.
  • This rate is higher for children who are operated on during their first year of life.
  • There is currently no significant difference between laparoscopic and open hernia repair methods. However, the advantage of the laparoscopic method is that it allows the surgeon to check whether the opposite side also has a hernia.
In this journal entry, I tried to explain that recurrence is possible after an inguinal hernia repair. There are also other potential complications, such as bleeding, infection, suture reactions, and anesthesia-related problems.
During the early years of my career, a senior surgeon once told me, “We surgeons always walk around wearing a shirt of fire; no matter what you do, something will get scorched.”
A surgeon who has never encountered complications is a surgeon who hasn’t performed surgeries. Our primary goal is to minimize these risks as much as possible.
As the saying goes, “He who watches over the lamb must always keep an eye out for the wolf.”
Let’s conclude this journal entry here. Stay healthy and happy!
October 2024
Prof. Dr. Egemen Eroğlu