in our unit we use 5 KG as land mark to do the surgery.to avoid the perioperative risk.

the risk of incarceration's during observation is very minimal .

we are happy with our result and we think it is a wise approach

We traditionally do inguinal hernia repair at 2 kg. Most of the premature kids are still in the hospital or just about to go home. The advantage is that the parents don't have to worry about incarceration or anything else. The disadvantage is that they need to be observed for postoperative apnea for at least 24h, so it sometimes delays discharge (which is a minor issue in these preemies who usually have been in the hospital for months).

I agree that the risk of incarceration is low, but nevertheless, it is real.

I would make it dependent on how far the family is from the hospital. If they live close by and can come over anytime if the hernia gets incarcerated, they can go home and you can do it electively when the child is bigger. If they live far away, have transport issues, it is probably better to fix the hernia before discharge.

Thank you Oliver

I agree with totally

but in case that patient is discharge from other hospital and show up in your private clinic / general hospital were no good NICU unit

plus the cost of one day in NICU is more than the cost of the surgery

you will still do it or wait until 5 kg .

it depends on the settings:

developed nations: as soon as possible

developing nations: due to lack of sophisticated anesthesia and lack pediatric case, if the hernia is not too large 4-5th month is best otherwise when the child got at least 5-6 kg weight the surgery is done.

Yea, traditionally I have used the 2 kg mark, but in some countries 5-6 kg may be more appropriate.

I'm surgeon for the adults

Inguinal hernia in preterm patients: defer surgical treatment if there are comorbidities that must be solved or at least stabilized. Ideally, it would be better to wait until the newborn reaches 2 kg of body weight, but if episodes of incarceration occur, the operation will be scheduled as soon as possible.

Reference: Cabrera Machado CA et al. Guía de Práctica Clínica de enfermedad herniaria inguinal de la niñez (Clinical Practice Guidelines children´s inguinal hernia disease). Rev Cuba Pediatr 2021;93(2):e1306. Available from: http://www.revpediatria.sld.cu/index.php/ped/article/view/1306/780

neonatal inguinal hernias should be repaired upon diagnosis. weight and age are really only an anesthetic difficulty. waiting puts you at risk of complications such as strangulation. and operating in an emergency is dangerous. 5 kgs we can operate them quietly

thank you

Interesting