Selective anterior annuloplasty during inguinal herniotomy in boys: an approach to further reduce hernia recurrence

BACKGROUND: Hernia recurrence is one of the most common complications after inguinal herniotomy (IH) in children. We describe a novel approach that involves adding anterior annuloplasty (AAP) during IH for selective high recurrence-risk children. OBJECTIVES: Evaluate the initial safety and effectiveness of selective AAP during IH in boys. DESIGN: Retrospective SETTING: Tertiary care center. PATIENTS AND METHODS: The study included boys younger than 15 who were selected to undergo either IH with or without AAP between January 2011 and January 2022. The preoperative recurrence risks were compared for the two groups. Cases who underwent other forms of hernia repair were excluded. MAIN OUTCOME MEASURES: The frequency of recurrence and other postoperative complications and the distribution of high recurrence-risks. SAMPLE SIZE: 315 boys; 143 underwent IH and AAP, while 172 had IH only. RESULTS: Among all the cases, only one recurrence was reported (0.3%). Other complications were hydrocele in 29 (9.2%), scrotal hematoma/inflammation in 9 (2.9%), and wound infection in 8 (2.6%), which resolved spontaneously in all cases. Compared to IH only, those selected for an additional AAP were significantly younger (3 [16%] vs. 12 [46%] months, P=.038) and more likely to be premature (35 [24.5%] vs. 15 [8.7%], P<.0001), frequently had extensive cremasteric adhesions (39.2% versus 3.5%, P<.0001) and had a higher rate of incarcerated hernia at presentation (6.3% versus 1.2%, P=.026). The high-recurrence risk group was almost twice as likely to be selected for an additional AAP compared to the low-risk group (143 vs. 75, P<.0001). CONCLUSION: Adding simple AAP to conventional hernia repair for high-recurrence risk boys can be a safe and effective step to reduce the overall risk of recurrence without increasing the incidence of other postoperative complications. LIMITATIONS: The study lacked a control group of patients to whom selective AAP would not be offered despite a high-recurrence risk. A prospective, controlled trial with a longer follow-up would lead to a stronger conclusion.