Surgical practice and outcome in 711 neonates and infants undergoing hernia repair in a large multicenter RCT: Secondary results from the GAS Study

Autor: Neil S. Morton, Geoff Frawley, Anne M. Lynn, Sarah J Arnup, Joss J. Thomas, Philip Ragg, Jurgen C. de Graaff, Girolamo Mattioli, Francesca Izzo, Davinia E. Withington, Alessio Pini Prato, Mary Ellen McCann, Peter Szmuk, Rodney W. Hunt, Andrew Davidson, Nicola Disma
Přispěvatelé: Anesthesiology
Rok vydání: 2018
Předmět:
Male
Hernia
medicine.medical_treatment
Hernia
Inguinal
Conduction
Global Health
Pediatrics
law.invention
Neonate
0302 clinical medicine
Randomized controlled trial
Anesthesia
Conduction
Recurrence
Risk Factors
law
Inguinal hernia repair
Anesthesia
Prospective Studies
Child
Outcome
Incidence
Incidence (epidemiology)
Gestational age
General Medicine
Perinatology and Child Health
Hernia repair
3. Good health
Treatment Outcome
surgical procedures
operative
Child
Preschool
Inguinal
030220 oncology & carcinogenesis
Female
medicine.medical_specialty
Anesthesia
General
03 medical and health sciences
030225 pediatrics
medicine
Humans
General
Preschool
Herniorrhaphy
business.industry
Infant
Newborn
Postmenstrual Age
Infant
Evidence-based medicine
Newborn
medicine.disease
Surgery
Follow-Up Studies
Pediatrics
Perinatology and Child Health
Inguinal hernia
business
Zdroj: Journal of Pediatric Surgery, 53(9), 1643-1650. W.B. Saunders
ISSN: 0022-3468
Popis: Background The GAS study is an international RCT to evaluate neurodevelopmental outcome comparing general plus regional anesthesia versus regional anesthesia alone in 722 neonates and infants who had inguinal hernia repair up to 60 weeks of postmenstrual age. This paper comprises a secondary descriptive analysis of hernias, aspects of surgery and outcomes. Methods The incidence of unilateral and bilateral hernias, side preponderance, predictive factors for bilateral hernias and surgical approaches were collated. Follow-up outcome data were examined at 2 years. Results Of 711 eligible patients, there were 679 with hernia data showing that 321 hernias were right-sided, 190 left and 168 bilateral. Male to female ratio was 5:1. Of those with unilateral hernias, 25.8% underwent contralateral exploration and in these cases a patent processus vaginalis was found in 68.9%. Bilateral hernias were more common in younger and female patients. At 2 years there was a recurrence rate of 0.99% and in 2.7% of patients a hernia was evident on the contralateral side (metachrony), and this was unrelated to the anesthesia technique. Conclusions Bilateral hernias are associated with lower gestational age at birth and female gender. There was a low incidence of complications and the anesthesia technique did not affect surgical outcome. Level of evidence Level 1 evidence from prospective treatment study.
Databáze: OpenAIRE
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