Two for One? Safety and Efficacy of Concomitant Hernia Repair During Pediatric Appendectomy.

INTRODUCTION

Appendicitis and inguinal hernias are among the most common surgical pathologies in the pediatric population. Laparoscopic surgery allows for visualization of the myopectineal orifices leading to incidental diagnosis of patent processus vaginalis or inguinal hernia in up to 5.7% of appendectomies. Despite the prevalence of these incidental diagnoses, there is no consensus on their management during appendectomy.

METHODS

We performed a retrospective cohort study using the Nationwide Readmissions Database to identify all pediatric (≤18 y old) patients who underwent appendectomy for uncomplicated and complicated appendicitis between 2016 and 2022. Patients who underwent concurrent inguinal hernia repair (IHR) during appendectomy were identified and compared to those who underwent appendectomy alone. Postoperative outcomes including infectious complications, wound complications, length of stay, cost of hospitalization, and readmission rates were analyzed after cohorts were propensity score matched.

RESULTS

There were 237,070 pediatric patients who underwent appendectomy alone and 140 patients underwent appendectomy with concurrent IHR. The median age, sex distribution, complicated appendicitis rates, and laparoscopic appendectomy rates were equivalent after cohorts were propensity score matched. Patients who underwent IHR had equivalent rates of postoperative complications and readmission rates. Patients who underwent IHR had shorter index hospital length of stay (3 d [interquartile range (IQR) 1-5] versus 4 d [IQR 2-8], P < 0.001) and reduced index hospitalization costs ($12,359 [IQR 11,602-23,291] versus $19,223 [IQR 14,545-132,137], P = 0.015).

CONCLUSIONS

Concurrent IHR during appendectomy is not associated with higher rates of complications or readmissions relative to appendectomy alone in the pediatric population. There is improved resource utilization when IHR is performed concurrently during appendectomy, reducing logistical and financial burdens on families.