Establishing benchmarks for the outcome of herniotomy in children

Background: Although complication rates following herniotomy in children are low, reported rates vary. The aim of this study was to propose desirable outcome measures that can be used by surgeons to assess the quality of their service. Methods: A review of prospectively collected data on all hernias operated on by the Christchurch-based paediatric surgical service was undertaken. Complication rates were determined and compared with those reported in the literature. Rates for children aged 1 year or above were compared with those in children aged less than 1 year. Results: There were 3128 herniotomies performed, with an overall recurrence rate of 0.6 per cent. Wound infections occurred in 0.9 per cent, but were confined to infants aged less than 12 months. The rate of acquired cryptorchidism was 0.4 per cent and testicular atrophy 0.8 per cent in boys. Injury to the vas deferens was recognized in 0.1 per cent. Children under 1 year of age were more likely to develop recurrence than older children (0.9 versus 0.2 per cent respectively; odds ratio 4.56, P = 0.013). Conclusion: Complication rates were relatively low compared with those reported previously, but were considered achievable in most paediatric surgical units. Specific attention should be paid to the youngest infants, as this group has the highest complication rate. Minimum standards can be proposed based on these and other published outcomes.