Frequency and complications of inguinal hernia repair in giant omphalocele.

PURPOSE: Giant omphalocele (GO) is a challenging problem owing to aberrant anatomy and complex comorbidities. Large inguinal hernias (IH) are known to occur in this population, but have not been well described in the literature. We sought to characterize rates and complications of IH in GO patients.

METHODS

A retrospective chart review was performed on all patients with the diagnosis of GO from 2004 to 2012, with a minimum follow-up period of 12 months. Statistical significance was calculated using Fisher's exact test and Mann-Whitney test (p<0.05).

RESULTS

A total of 51 giant omphalocele patients were born during the 8-year study period, with IH diagnosed in 21 patients (41%). IH was not associated with gestational age, birth weight, or method of GO closure, but was significantly associated with male gender (p<0.0001). Incarceration occurred in 4 patients (19%). Recurrence was noted in 7 cases, with 6/7 recurrences following repair by high ligation of the sac alone. All recurrences were repaired with the Bassini repair. Postoperative complications were noted in 7 patients (33%) and included prolonged ileus following incarceration, testicular tethering, testicular atrophy, persistent hydrocele, and death following acute incarceration.

CONCLUSIONS

Our study suggests a high incidence of IH in GO patients. The prevalance of incarceration and recurrences in these patients support a role for inguinal herniorrhaphy via a Bassini repair prior to initial hospital discharge.