Chapter 1 of 9 · Surgical Management
Preemie timing
Timing of hernia repair in premature infants
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Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
2026 Laparoscopic Pediatric Hernia Repair
123 min · Published Jun 2026
Video
Laparoscopic Pediatric Hernia Repair: Online Course 2017
Dr. Todd Ponsky · 102 min · Published Aug 2017
Video
2024 Laparoscopic Hernia Event
102 min · Published Jun 2024
Video
Focus on Technique- Laparoscopic Pediatric Hernia Repair 2015
Dr. Todd Ponsky · 140 min · Published Mar 2014
Video
Groin Controversies - Todd Ponsky: Update Course 2014
Dr. Todd Ponsky · 28 min · Published Nov 2018
Video
Groin Controversies: Update Course 2016
Dr. Todd Ponsky · 28 min · Published Jul 2017
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Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal
71 min · Published Sep 2026
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Clinical & Research Update: Neuroblastoma with Drs. Katherine Somers, Cara Morin, Juan Gurria, and Meera Kotagal
67 min · Published Sep 2026
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Clinical & Research Update: Sarcoma w/ Drs. Roshni Dasgupta, Joseph Pressey, Arthur Meyer, Luke Pater
66 min · Published Sep 2026
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Beyond the Spectrum: Diagnosis, Myths & Management - Caitlin Couch & Leslie Lopez - APP Conference 2026
50 min · Published May 2026
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Dysautonomia: Navigating the Journey - Martha Willis - APP Conference 2026
55 min · Published May 2026
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Everything You Ever Wanted to Know About G-tubes But Were Afraid to Ask - Betsy Gerrein - APP Conference 2026
30 min · Published May 2026
What the experts said
Only 20% of patent processus vaginalis cases will ever become a clinical hernia
80% of pediatric hernia incarcerations occur in children under 12 months of age
Most anesthesia neurocognitive data is from animal studies, not human data, so direct extrapolation is uncertain
Reincarceration rate after reduction starts to go back up at 72 hours based on published data
Incarcerated ovaries likely reduce spontaneously and come and go, so urgent repair may not be necessary
Testicular ischemia is harder to control for than bowel ischemia in incarcerated hernias
Operating unnecessarily on patent processus that will never incarcerate may expose testis to injury
Inguinodynia (chronic groin pain) is much more common in older patients than young children after open inguinal hernia repair
Laparoscopic approach allows clear visualization of inguinal floor to distinguish indirect hernia from direct/floor problem
Mesh repair has significant risk of vas deferens injury
Todd Ponsky's laparoscopic series has approximately 2% recurrence rate (unpublished, anecdotal: 1 repair out of several hundred cases)
Laparoscopic hernia repair is more expensive than open due to equipment and need for extra nurse
In rabbit model, laparoscopic hernia repair with stitch alone failed when stitch was cut at 2 months; adding cautery before cutting stitch resulted in all repairs staying closed
Learning curve for laparoscopic hernia repair may be 30-40 cases before recurrence rate becomes acceptably low
Closing hernia sac during contaminated case (perforated appendicitis) risks creating scrotal abscess
Umbilical hernia size does not predict need for earlier repair; no data supports operating earlier on larger defects
Umbilical hernias can close spontaneously up to 8-10 years of age if getting smaller
Epigastric hernias can become symptomatic in overweight teenagers and are difficult to localize on exam
Operating on epigastric hernias when patient is too young with diastasis recti may result in more hernias developing later
Jack Langer's data shows very high incarceration rate in newborns and preemies with inguinal hernias
68% of audience members repair premature infant bilateral inguinal hernias prior to NICU discharge
If you have a patent processus vaginalis, you have 4 times greater risk than general population of developing a hernia on that side
VA cooperative study in adults showed 1.7% incidence of incarceration in adults with inguinal hernia
Data on anesthesia neurocognitive risk in premature infants is immature; unclear what the risk is or whether it's impacted by duration of case or age of child
Torsed ovaries that are 5cm and black survive when detorsed rather than removed
Mayo Clinic 50-year follow-up study shows most common cause of recurrence after open pediatric inguinal hernia repair is a direct hernia
Mesh inguinal hernia repair has 30% incidence of chronic pain, validated in multiple studies
Felix Schier's laparoscopic Z-stitch technique has about 6% recurrence rate
SEAL technique (Craig Albanese, Mike Harrison, Sanjeev Dutta at Stanford) reports 1.2% recurrence rate, but other centers using it report 3-4%
CK Young's extraperitoneal percutaneous technique has less than 1% recurrence (unpublished data)
Open inguinal hernia repair recurrence rate is about 1% based on large published series (Ein: 5000 cases, Atkins: 4000 cases)
Studies show decreased sperm quality in patients who had bilateral inguinal hernia repairs, but infertility rate did not appear different in most studies
There are reports of postoperative cryptorchidism after hernia repair at a rate of a few percent