O3290: Evaluation of Mesh Placement in Adolescents Undergoing Inguinal Hernia Repair: A Multicenter Retrospective Cohort Study

Background: Inguinal hernia repair (IHR) varies between children and adults, with adults commonly undergoing mesh placement by laparoscopic or robotic approaches. The aims of this study were to evaluate incidence of mesh placement in adolescent patients who underwent inguinal hernia repair by pediatric general surgeons in the U.S. and to evaluate incidence of recurrence in relation to mesh placement.

Methods: A retrospective chart review was conducted of pediatric patients who underwent initial IHR by pediatric surgeons at 20 U.S. hospitals from 2017 through 2019, with follow-up through the end of 2022. Patients were identified by one of thirteen CPT codes for IHR and were included in analysis if they were aged 12 or older. Patients with undescended testis and recurrent hernia repair were excluded. The primary outcomes were mesh placement and hernia recurrence. Demographic, operative, and follow-up data were collected in REDCap. Major diagnosis included history of omphalocele, pulmonary hypertension, congenital heart defect requiring intervention, connective tissue disorder, and ventriculoperitoneal shunt. Chi-square and Fisher’s exact test were performed for comparison of categorical variables. Mann Whitney U test was used to compare nonnormally distributed continuous variables. SPSS was used for analysis, and statistical significance was set at p< 0.05.

Results: A total of 708 adolescents were included in the analysis: 78.1% were male with median age 15 years [IQR 13-16] and median BMI 20.6 kg/m2 [IQR 18.2-23.4]. Fifty-five patients (7.8%) had mesh placed during IHR, and nine patients (1.3%) had a documented hernia recurrence (Table 1). On bivariate analysis, male sex, age, weight, and BMI were significantly associated with mesh placement (Table 2). Of patients who had mesh placed, 85% (47/55) underwent an open approach. Major diagnosis, concomitant procedure, hernia incarceration, and surgical approach were not statistically different between mesh and no mesh groups. All but one hernia recurrence occurred in the no-mesh group, though this did not reach statistical significance (p=0.519).

Conclusion: Less than 8% of adolescents who underwent IHR by pediatric general surgeons had mesh placed. Laparoscopic mesh repair has not been widely adopted. Recurrence with minimum three-year follow-up was low at 1.3%, which may reflect that high ligation without mesh placement is adequate in adolescents.