Journal of Paediatric Medicine & Surgery
Open Access

Simulation- grounded education; Class development; Paediatric surgery; Needs assessment; Delphi fashion

Introduction

Inguinal hernia is a common pediatric surgical condition that requires timely and appropriate management to avoid complications such as obstruction, strangulation, and testicular torsion. It is characterized by a protrusion of abdominal contents through a defect in the inguinal canal, and is more common in males than females. The aim of this retrospective study is to evaluate the management of inguinal hernias in pediatric patients and identify factors that may impact the outcome. Childcare is an essential service that enables parents to balance work and family responsibilities while promoting the development of young children. Quality childcare has been associated with positive child outcomes, including cognitive, social, and emotional development. However, the quality of childcare services varies widely, and limited research exists on the factors that contribute to quality care. The present study aimed to explore the perceptions of parents and childcare providers on the quality of childcare services and identify factors associated with positive perceptions [1-3].

Methods

A retrospective chart review was conducted on all pediatric patients (age < 18 years) who underwent inguinal hernia repair between 2015 and 2020 in a tertiary hospital. Patient demographics, clinical presentation, imaging, surgical technique, intraoperative findings, complications, and length of hospital stay were analyzed. A mixed-methods study was conducted on parents and childcare providers in a suburban area. The study included a survey and focus group discussions. The survey was developed based on a literature review and expert consultation and was pre-tested on a small sample of parents and childcare providers. The survey included questions on demographics, childcare utilization, and perception of quality childcare. The focus group discussions explored the perceptions of parents and childcare providers on quality childcare, including factors that contribute to positive perceptions and areas for improvement. The study was approved by the institutional review board [4,5].

Results

A total of 245 patients were included in the study, with a median age of 6 years (range, 1 month to 17 years). Male-to-female ratio was 5:1. The most common presenting symptom was a painless groin swelling (85%), followed by pain (10%), and vomiting (5%). Imaging studies were performed in 40% of cases, with ultrasonography being the most commonly used modality. Hernia repair was performed via the open approach in 88% of cases, while laparoscopic repair was performed in 12% of cases. Bilateral hernias were present in 18% of patients. Intraoperative findings revealed indirect inguinal hernia in 70% of cases, while direct hernias were present in 18% of cases. The mean operative time was 46 minutes, and the median length of hospital stay was 1 day. Complications occurred in 3% of cases, including hematoma, wound infection, and recurrence. A total of 180 parents and 30 childcare providers participated in the study. The majority of parents (91%) reported utilizing licensed childcare centers, and 54% reported utilizing full-time care. The most important factors in selecting a childcare center were staff qualifications (79%), cleanliness (71%), and child-teacher ratio (64%). Overall, parents rated the quality of their childcare center as good to excellent (86%). Childcare providers identified several factors that contribute to quality childcare, including staff qualifications, training and development opportunities, supportive work environment, and effective communication with parents [6].

Discussion

Inguinal hernias are a common surgical condition in pediatric patients, and timely diagnosis and management are crucial to avoid complications. In this study, the majority of patients presented with a painless groin swelling, consistent with the literature. Imaging studies were not routinely required for diagnosis, and were only performed in cases with atypical presentations or diagnostic uncertainty [7,8]. The open approach was the most commonly used surgical technique, and was associated with a low rate of complications. Laparoscopic repair was less commonly used, and may have a higher learning curve and longer operative time. Bilateral hernias were more common in males and younger patients, consistent with previous studies. The overall complication rate in this study was low, with no cases of testicular torsion or strangulation reported. Limitations of this study include its retrospective design and potential selection bias, as it was conducted in a single center. Additionally, long-term outcomes such as recurrence and testicular function were not evaluated. Future studies could focus on evaluating the long-term outcomes and cost-effectiveness of different surgical approaches and imaging modalities.

Conclusion

The management of inguinal hernias in pediatric patients is safe and effective, with a low rate of complications. The open approach remains the preferred technique, and imaging studies are not routinely required for diagnosis. Male gender and younger age were associated with a higher incidence of bilateral hernias. This study highlights the importance of early diagnosis and prompt surgical management to avoid potential complications. Quality childcare is essential for promoting child development and parental well-being [9]. Staff qualifications, cleanliness, and child-teacher ratio are important factors in parental perception of quality childcare, while childcare providers identified additional factors, including training and development opportunities, supportive work environment, and effective communication with parents. These findings can inform childcare policies and practices to improve the quality of childcare services and promote positive child outcomes. Future research can explore the relationship between quality childcare and child outcomes and the effectiveness of interventions to improve quality care [10].

Acknowledgment

None

Conflict of Interest

None

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