Authors: Abdullah Alshehri , Fatimah Almabyouq , Renad Almutawa , Zahra Almatar , Ahmed Alfayez , Khaled Alfifi , Yasser Alfraih , Tariq Altokhais

Abstract

Background: Delayed management of pediatric inguinal hernias can lead to serious complications. We sought to determine the effect of delayed elective surgery on uncomplicated inguinal hernias in children and parents’ emotional perspectives and anxiety levels during the COVID-19 pandemic.

Methods: This multicenter prospective cohort study included all pediatric patients ≤ 14 years of age with inguinal hernia who were initially scheduled for surgery but were postponed during the national lockdown between March and September 2020. The incidence of all hernia-related complications while awaiting surgery was analyzed. We also surveyed the patients’ parents regarding their perspectives, anxiety, and the impact of delayed surgery on their children’s well-being.

Results: Forty-eight patients were included in the study. Primary inguinal hernias were noted in 45 (93.8%) patients. Half of the patients had one or more hernia-related emergency room (ER) visits, 18 (37.5%) had one or more hernia incarcerations, and 13 (27.1%) needed emergency hernia repairs. The median waiting time for patients requiring emergency surgery was 65 days. The cumulative hazard of complications increased as the surgical intervention was delayed. Composite complications (defined as any hernia-related ER visit, incarceration, or emergency surgical repair) occurred within a median duration of 167 days. Many parents were concerned about their child’s problems and were worried about the exposure to the COVID-19 virus if operated during the pandemic.

Conclusion: Hernia-related complications were high because elective inguinal hernia repair was delayed during the COVID-19 lockdown. To minimize these complications, surgical repair should be carefully timed, particularly during a pandemic.

Keywords: Inguinal hernia, COVID-19, Pandemic, Children.