Inguinal Hernia in Children: Epidemiology, Clinical Presentation, Management, and Timeliness of Surgical Intervention A Prospective Study from Al-Karama Teaching Hospital, Iraq
DOI:
https://doi.org/10.31149/ijimm.v4i1.2462Keywords:
Inguinal Hernia, Pediatric Surgery, Incarceration, Health Literacy, Timely Referral, Iraq, Surgical Delay, Primary Care Integration, Caregiver Awareness, Resource-Limited SettingAbstract
Inguinal hernia is one of the most common surgical conditions that are experienced by children around the world with an approximate incidence of 1-5 percent of full-term babies and much higher figures of preterm babies. The lack of access to timely surgical care, inconsistency in the knowledge of providers of primary care, and inconsistent health literacy of caregivers in low- and middle-income countries, including Iraq, contributes to the delay in diagnosis and management. These delays increase the risk of life and organ-threatening complications, especially incarceration and strangulation that might require emergency treatment and are linked to higher morbidity and healthcare expenditure. The aim of the study was to fully describe the demographic, clinical, and perioperative characteristics of pediatric inguinal hernias treated in the Al-Karama Teaching Hospital tertiary referral center in the Wasit Governorate, Iraq and evaluate how patient-level (e.g., caregiver awareness, symptom recognition) and system-level (e.g., referral pathways, primary care engagement) factors affected when patients could refer to the hospital and receive surgical treatment. Our study was a prospective observational cohort study that was done in January 2023 and continued till October 2024. Children with inguinal hernia and all children between the age of 0 and 14 years referred to our surgical unit were enlisted consecutively on the basis of informed consent, as signed by the legal guardians. It was designed to record patient data about sociodemographic factors, clinical presentation (laterality, reducibility and occurrence of complications), source of referral, health literacy measures, surgical procedure, findings during the operation, postoperative performance, and follow-up outcome, using a standardized data collection tool. The IBM SPSS Statistics version 28 was used to analyze the data. Inferential statistics were used to identify predictors of delayed presentation (more than 7 days between symptoms recognition and surgical consultation) and complication risk by using Chi-square, independent samples t-tests, and multivariate logistic regression as the descriptive statistics to summarize the cohort profile. There were 218 children enrolled, 172 (78.9) of them were male. The median age at presentation was 2.4 (2.1) years with a bimodal distribution with infant age (<1 year) and early childhood (2-4 years) having the highest median. Hernias on the right side were predominant (56.4%), and left-sided (35.3%), and bilateral (8.3%). It is important to note that 62 children (28.4) presented with incarcerated hernias with 11 children (5.0) having signs indicative of early strangulation. The duration of the time between the recognition of the symptoms by caregivers and the first surgical consultation was 14 days (interquartile range [IQR]: 6–30). Caregivers who had better scores of health literacy (measured through a 10-item validated questionnaire) were much more likely to seek timely care (p = 0.003). Only 22.5% of the cases were referred by primary care center, with self-referral or non-physician referral as the majority (64.7). The surgical treatment was mainly open high ligation (99.1%), and laparoscopic repair was done in two recurrent cases that were complex. The entire recurrence rate was 0.9% (n = 2) and there was no perioperative mortality. Although inguinal hernia repair is a technically straight forward procedure, significant lapses in care continue to be present in our environment with much of the reason being due to lack of caregiver knowledge of the disorder and a steady lack of connection between primary care and surgical units. Presenting incarceration rates is still frightening, which stresses that immediate measures are necessary. Reinforcing the initial identification via community health education, increasing the capacity to diagnose at the primary care level, and putting in place systemic systems of referral regimes would help considerably in deterring complications that are avoidable. The results are in line with Sustainable Development Goal 3 (Good Health and Well-being), which recommends equal and accessible timely access to necessary surgical services among children in resource-constrained settings.
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