Pediatric Inguinal Hernia: A Prospective Study of Epidemiology, Clinical Features, Management Strategies, and Timing of Surgical Repair at Al-Karama Teaching Hospital, Iraq

Abstract

Background: Pediatric inguinal hernia is a common surgical condition in children and may progress to incarceration and strangulation when recognition, referral, and repair are delayed, particularly in low- resource settings. Objective: To characterize the epidemiology, presentation pathways, management, and factors associated with delayed consultation and incarceration among children with inguinal hernia at Al-Karama Teaching Hospital, Wasit Governorate, Iraq. Methods: A prospective observational co- hort study was conducted from January 2023 to October 2024 and included children aged 0–14 years with clinically confirmed inguinal hernia. Data on demographics, clinical presentation, referral pathways, care- giver health literacy, surgical management, and outcomes were collected using a standardized case report form. Bivariate analyses compared presentation within 7 days versus >7 days, and multivariate logistic regression was used to identify independent predictors of incarceration. Results: A total of 218 children were enrolled; 78.9% were male, with a mean age of 2.4 ± 2.1 years. Incarceration occurred in 28.4% of cases, and 3.7% required bowel resection. Symptom-to-consultation delay >14 days, age <1 year, and non-PHC referral were independent predictors of incarceration. Adequate caregiver health literacy was significantly associated with earlier presentation (p = 0.003). Open high ligation was performed in 99.1% of cases, with no perioperative mortality and a recurrence rate of 0.9%. Conclusion: Pediatric inguinal hernia in Wasit Governorate is associated with a high burden of potentially preventable incarceration, driven largely by delayed presentation, limited caregiver awareness, and fragmented referral pathways. Strengthening caregiver education and improving primary care integration may facilitate earlier surgical access and reduce avoidable complications.