Retrospective Cohort Study on Inguinal Hernia in Children: Infant Vulnerability to Incarceration and Pediatricians’ Awareness

Abstract Objectives: The objective of this study was to evaluate the risk of incarceration with delayed repair in infants with inguinal hernia and to assess paediatricians’ knowledge and practices regarding the timing of surgery. Materials and Methods: This mixed-methods study combined a retrospective cohort of children (<16 years) who underwent inguinal herniotomy between January 2020 and December 2024 with a cross-sectional knowledge, attitudes, and practices survey among pediatricians. Demographics, wait time, complications, and postoperative outcomes were analyzed. The survey assessed diagnostic and referral practices. Logistic regression could not be performed due to the small number of events; therefore, unadjusted comparisons were analyzed using appropriate parametric or nonparametric tests. Results: Of 230 children, 94 (41%) were infants. Complicated hernia occurred in 24 (10.4%), including 15 infants (62.5%). Infants had a higher risk of incarceration than older children (15.9% vs. 6.6%; relative risk 2.41; P < 0.05). Among infants, a wait time ≥2 weeks was associated with a nonsignificantly higher odds of complications than <2 weeks (odds ratio, 2.20; 95% confidence interval, 0.36–13.4; P = 0.44). Complicated hernias had a more extended hospital stay (2.7 vs. 1.2 days) and a higher surgical site infection rate (12.5% vs. 1.0%; P < 0.05). Among 66 pediatricians surveyed, 27 (41%) were unsure or advised a delay despite guidelines recommending early repair. Over half (56%) advised ultrasound for clinically evident hernia. Conclusion: Infants constitute a disproportionately high share of complicated hernias. Although longer wait time showed a trend toward increased risk, this association was not statistically significant in this sample. Variable recommendations among pediatricians highlight the need for clear referral guidelines and parental counseling.