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Wolak PK, Strzelecka A, Piotrowska A, Dąbrowska K, Wolak PP, Piotrowska I, Nowak-Starz G. The Operative Time for Unilateral Inguinal Hernia Repair in Children Performed with Percutaneous Internal Ring Suturing (PIRS) or Open Approach Method. J Clin Med 2021; 10:jcm10061293. [PMID: 33800993 PMCID: PMC8004003 DOI: 10.3390/jcm10061293] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
In this study, we compared the operative time for unilateral inguinal hernia repair in children performed with either an open approach (OA) or the Percutaneous Internal Ring Suturing (PIRS) method. It was a retrospective chart review of all patients ages 0 to 18 who underwent unilateral inguinal hernia repair in the Department of Pediatric Surgery, Urology and Traumatology of the Regional Hospital in Kielce between January 2011 and December 2018. Patients with bilateral hernias or additional problems were excluded. Of 878 patients qualified for the study, 701 were in the OA group and 177 in the PIRS group. Overall, the time needed to complete the procedure was significantly longer for the OA method. The operative time was longer if the hernia was left-sided (p = 0.024). Analysis by gender showed that operative time was generally longer in males. For both genders, surgery was shorter if the PIRS method was used. For males in the PIRS group the operative time was affected by the location of the hernia, and it was longer for a left-sided hernia. The take-home message is that the PIRS procedure is faster than the OA for inguinal hernia repair in children and it might be considered as a preferred method, especially in females.
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Affiliation(s)
- Przemyslaw Karol Wolak
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
- Department of Pediatric Surgery, Urology and Traumatology Provincial Hospital, ul. Grunwaldzka 45, 25-736 Kielce, Poland
- Correspondence: ; Tel.: +48-501-525-549
| | - Agnieszka Strzelecka
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
| | - Aneta Piotrowska
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
| | - Katarzyna Dąbrowska
- Department of Neonatology and Neonatal Intensive Care, Polish Mothers Health Research Institute, ul. Rzgowska 281/289, 93-338 Łódź, Poland;
| | | | - Ilona Piotrowska
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
| | - Grażyna Nowak-Starz
- Collegium Medicum, Jan Kochanowski University, ul. Żeromskiego 5, 25-369 Kielce, Poland; (A.S.); (A.P.); (I.P.); (G.N.-S.)
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Staerkle RF, Guglielmetti LC, Bielicki IN, Gaukel S, Frongia G, Hilton S, Fink L, Vuille-dit-Bille RN. Is it worth to explore the contralateral side in unilateral childhood inguinal hernia?: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2020; 99:e21501. [PMID: 32756186 PMCID: PMC7402905 DOI: 10.1097/md.0000000000021501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is still not clear if the contralateral side should be explored in children with unilateral inguinal hernias. The primary aim of the present study was to assess the incidence of metachronous contralateral inguinal hernias (MCIHs) in the pediatric population. The second aim was to assess factors associated with increased risk of MCIH development. METHODS Prospective studies including patients from 0-19 years undergoing unilateral inguinal hernia repair without surgical exploration of the contralateral side between 1947 and April 2020 with a minimal follow-up of one year were searched. Searches included EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. RESULTS Seven studies involving 1774 children (1452 boys (82%) and 322 girls (18%) were identified. Overall the incidence of MCIH was 6%. Incidence of MCIH development was significantly higher in children with initial left-sided (9%) versus right-sided (3%) hernia (OR 2.55 with 95% CI from 1.56 to 4.17; P = 0.0002), in female (8%) versus male (4%) children (OR 1.74 with 95% CI from 1.01 to 3.01; P = 0.0469) and in patients with open (14%) versus closed (3%) contralateral processus vaginalis (CPV) (OR 4.17 with 95% CI from 1.25 to 13.9; P = 0.0202). There was no significant difference in MCIH development depending on follow-up duration (follow-up of ≤2 years (i.e. 1-2 years): calculated MCIH incidence 5% (95% CI from 0.00 to 0.11%; 3 studies; 569 patients), follow-up of ≥3 years (i.e. 3-4 years): 6% (95% CI from 0.03 to 0.09; 3 studies, 983 patients)) or patients' age (MCIH incidence in children <1 year: 6.9%; older children: 4.5%; OR 1.87 with 95% CI from 0.97 to 3.62; P = 0.0618). CONCLUSIONS Overall incidence of MCIH development is 6%. Initial left-sided hernia, female gender and open CPV are risk factors for MCIH development.
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Affiliation(s)
- Ralph F. Staerkle
- Clarunis University Center for Gastrointestinal and Liver Diseases, Basel
| | - Laura C. Guglielmetti
- Department of Visceral und Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur
| | | | - Stefan Gaukel
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Giovanni Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Hilton
- Department of Surgery, University of Colorado, Aurora, CO
| | - Lukas Fink
- Department of Mathematics, Cantonal School of Wil, St Gallen, Switzerland
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Basha MAA, Saber S, El-Hamid M Abdalla AA, Aly SA, GObran T, Waly A, Arafa AS. Assessment of the testicular vascularity after inguinal herniotomy in children: a prospective color Doppler study. Acta Radiol 2020; 61:128-135. [PMID: 31091967 DOI: 10.1177/0284185119851236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Knowing transient vascular perfusion abnormalities of testes after open inguinal herniotomy procedure is essential for the surgeon who is mainly responsible for the patient outcome. Purpose To assess the effect of open inguinal herniotomy procedure on the testicular blood supply in children using duplex ultrasonography (DUS). Material and Methods A prospective observational study included 60 boys (mean age = 9.46 ± 14.46 months; age range = 2 months–6 years) who underwent open inguinal herniotomy operation. Using DUS, the testicular volume, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were calculated preoperatively and one week, one month, and six months postoperatively. The pre- and postoperative measurements were compared. Statistical analysis was performed using χ2 test, Fisher’s exact test, or Student’s t-test when appropriate. Results On physical examination, the hernias were unilateral in 57 boys and bilateral in three boys. Comparison between testicular volumes preoperatively and postoperatively showed no significant change ( P > 0.05). There was a statistically significant increase of PSV and RI one week and one month postoperatively ( P < 0.0001) but returned to be near to the preoperative values at six months. As regards EDV, there was a slight but non-significant postoperative increase ( P > 0.05) which did not return to the preoperative value. Conclusion The affection of testicular vascularity postoperatively is transient and returns to be near to the preoperative values in the late postoperative period (six months postoperatively). Additionally, no significant change in testicular volume postoperatively.
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Affiliation(s)
| | - Sameh Saber
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | | | | | - T GObran
- Department of Pediatric Surgery, Zagazig University, Zagazig, Egypt
| | - Amira Waly
- Department of Pediatric Surgery, Zagazig University, Zagazig, Egypt
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Lin J, Li D, Chen J, Lin L, Xu Y. Inguinal hernia repair by Bianchi incision in boys: a retrospective study. Pediatr Surg Int 2018; 34:289-295. [PMID: 29188379 DOI: 10.1007/s00383-017-4217-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Open inguinal hernia repair by Bianchi incision is a potential alternative technique for the treatment of IH. This study aims to retrospectively analyze boys with IH, who underwent open IH repair by Bianchi incision. METHODS A total of 3300 boys (1-144 months) with IH from April 2007 to September 2015 were enrolled into this study. An open high scrotal incision (Bianchi incision) to ligate the processus proximal to the internal inguinal ring was performed in patients for IH repair. Then, all patients were followed up after 7 days, 1 month, and 1 year. Operation time, hernia recurrence, hydrocele, testicular atrophy, cosmetic results, and the satisfaction of parents were evaluated. RESULTS Among these 3300 boys, 1662 (50.36%) and 1349 (40.88%) boys with IH were operated on the right and left side, respectively, while 289 (8.76%) patients underwent bilateral surgery. The average operation time was 13.0 ± 2.3 min for unilateral cases and 25.2 ± 4.2 min for bilateral cases. Furthermore, among these 3300 boys, 309 boys (9.36%) were lost to follow-up, and the remaining 2991 boys underwent a total of 3245 IH repairs. The complications included 20 recurrences who were repaired with the same technique, one wound rupture, and one acquired undescended testis. No infection, obvious scrotal hematoma, testicular atrophy, and vas deferens injury were found during the follow-up. In most instances, the scars were invisible, obtaining an excellent cosmetic effect. CONCLUSION Inguinal hernia repair by Bianchi incision is a safe, easy and effective technique with cosmetic benefits, which could be a reliable alternative for the treatment of pediatric inguinal hernia.
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Affiliation(s)
- Junshan Lin
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Dumiao Li
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Jinwen Chen
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Li Lin
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Yali Xu
- Pediatric Surgery Department of the First Affiliated Hospital of Fujian Medical University, The First Clinical Medical College of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350004, Fujian, China.
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The advantages of transumbilical single-site laparoscopic percutaneous extraperitoneal closure for inguinal hernia in 1583 children. Surg Endosc 2017; 32:1923-1928. [DOI: 10.1007/s00464-017-5885-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022]
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Ksia A, Braiki M, Ouaghnan W, Sfar S, Ammar S, Youssef SB, Boussaffara B, Sahnoun L, Mekki M, Belghith M, Nouri A. Male Gender and Prematurity are Risk Factors for Incarceration in Pediatric Inguinal Hernia: A Study of 922 Children. J Indian Assoc Pediatr Surg 2017; 22:139-143. [PMID: 28694569 PMCID: PMC5473298 DOI: 10.4103/jiaps.jiaps_166_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: The purpose of this study was to document clinical features of inguinal hernia (IH) in the pediatric population. It provides data to evaluate associated risk factors of incarcerated hernia, its recurrence as well as the occurrence of contralateral metachronous hernia. Materials and Methods: We report a retrospective analytic study including 922 children presenting with IH and operated from 2010 to 2013 in our pediatric surgery department. Results: We managed 143 girls (16%) and 779 boys (84%). The mean age was 2 years; the right side was predominantly affected (66.8%, n = 616). Incarcerated hernia was documented in 16% of cases with an incidence of 33% in neonates. The incarceration occurrence was 15.5% in males versus 2.09% in females. The surgical repair was done according to Forgue technique. Postoperatively, four cases of hernia recurrence were documented, and contralateral metachronous hernia was reported in 33 children with 7.7% females versus 2.8% males. Forty-five percent of them were infants. The mean follow-up period was 4 years. We think that incarceration can be related to several risk factors such as feminine gender, prematurity, and the initial left side surgical repair of the hernia. Conclusion: IH occurs mainly in male infants. Prematurity and male gender were identified as risk factors of incarceration. Contralateral metachronous hernia was reported, especially in female infants and after a left side surgical repair of the hernia.
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Affiliation(s)
- Amine Ksia
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Meriem Braiki
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Wissal Ouaghnan
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Sami Sfar
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Seloua Ammar
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Sabrine Ben Youssef
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Bochra Boussaffara
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Lassaad Sahnoun
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Mongi Mekki
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Mohsen Belghith
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
| | - Abdellatif Nouri
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba University Hospital, Monastir University, Tunisia Laboratory of Research, LR12SP13, Monastir, Tunisia
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Esposito C, Escolino M, Turrà F, Roberti A, Cerulo M, Farina A, Caiazzo S, Cortese G, Servillo G, Settimi A. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg 2016; 25:232-40. [PMID: 27521714 DOI: 10.1053/j.sempedsurg.2016.05.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. This article reviews current concepts in the management of inguinal hernia and hydrocele based on the recent literature and the authors׳ experience. We describe the principles of clinical assessment and anesthetic management of children undergoing repair of inguinal hernia, underlining the differences between an inguinal approach and minimally invasive surgery (MIS). Other points discussed include the current management of particular aspects of these pathologies such as bilateral hernias; contralateral patency of the peritoneal processus vaginalis; hernias in premature infants; direct, femoral, and other rare hernias; and the management of incarcerated or recurrent hernias. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele, emphasizing that the current use of MIS in pediatric patients has completely changed the management of pediatric inguinal hernias.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131.
| | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Francesco Turrà
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Agnese Roberti
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Mariapina Cerulo
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Alessandra Farina
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Simona Caiazzo
- Department of Anesthesiology, Federico II University, Naples, Italy
| | - Giuseppe Cortese
- Department of Anesthesiology, Federico II University, Naples, Italy
| | | | - Alessandro Settimi
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
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Wenk K, Sick B, Sasse T, Moehrlen U, Meuli M, Vuille-dit-Bille RN. Incidence of metachronous contralateral inguinal hernias in children following unilateral repair - A meta-analysis of prospective studies. J Pediatr Surg 2015; 50:2147-54. [PMID: 26455468 DOI: 10.1016/j.jpedsurg.2015.08.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/22/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this review was to systematically evaluate the incidence of a metachronous contralateral inguinal hernia (MCIH) in children with unilateral inguinal hernia and therefore to propose or to reject routine contralateral groin exploration. METHODS Electronic searches restricted to prospective studies with a minimal follow-up of 1year included MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. RESULTS Six studies involving 1669 children were included. Overall MCIH was 6% (95% CI from 4% to 8%). The odds for MCIH development were significantly larger in children with an initial left-sided hernia (OR 2.66 with 95% CI from 1.56 to 4.53) and in children with open contralateral processus vaginalis (CPV) (OR 4.17 with 95% CI from 1.25 to 13.9). CONCLUSIONS The overall incidence of MCIH following unilateral inguinal hernia repair in children is 6%. Initial left-sided hernia (8.5%) and open CPV (13.8%) are risk factors for MCIH development. Female gender (8.2%) and younger age (<1year) (6.9%) non-significantly increase the risk of MCIH.
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Affiliation(s)
- Kathrin Wenk
- Emergency Department, Hospital Baden, Baden, Switzerland
| | - Beate Sick
- Epidemiology, Biostatistics, and Prevention Institute (EBPI) at the University of Zurich, Zürich, Switzerland
| | - Tom Sasse
- University of Zurich, Zürich, Switzerland
| | - Ueli Moehrlen
- Pediatric Surgery, University Children's Hospital of Zurich, Zürich, Switzerland
| | - Martin Meuli
- Pediatric Surgery, University Children's Hospital of Zurich, Zürich, Switzerland
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Esposito C, St Peter SD, Escolino M, Juang D, Settimi A, Holcomb GW. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review. J Laparoendosc Adv Surg Tech A 2014; 24:811-8. [PMID: 25299121 DOI: 10.1089/lap.2014.0194] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM Inguinal hernia is one of the most common surgical conditions in infants and children. However, considerable debate exists regarding the role of laparoscopic hernia repair (herniorrhaphy) (LH) and its benefits over conventional open hernia repair (herniorrhaphy) (OH). The aim of this review is to analyze the current literature to determine the outcome of LH compared with OH. MATERIALS AND METHODS A literature search was performed on all studies published during the last 20 years, reporting on outcomes of OH and LH, in terms of operative time, recurrence rate and other complications, finding of rare hernias, and incidence of contralateral patency. The chi-squared or Fisher's exact test was used to analyze the results of the study. RESULTS Fifty-three studies matched our inclusion criteria. As for operative time, in unilateral inguinal hernia repair, there was no significant difference between LH and OH (P=.33). In contrast, in bilateral disease, LH is faster than OH (P=.01). As for the recurrence rate, no significant difference was observed between the two techniques (P=.66), whereas the rate of other complications was significantly higher for OH compared with LH (P=.001). Laparoscopy has the advantage to identify and treat rare hernias (direct, femoral, "en pantalon") that are never reported in articles focused on inguinal OH. In laparoscopic series, in the case of unilateral hernia, the incidence of contralateral patency varied between 19.9% and 66%. CONCLUSIONS In this systematic review, it seems that LH is faster than OH for bilateral hernias, whereas there is no significant difference in terms of operative time for unilateral inguinal hernia repair. Recurrence rate is similar for both techniques. As for other complications such as wound infections, it is higher for OH compared with LH, especially in infants. A prospective comparative study is necessary on this topic to strongly support the results of our systematic review.
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Affiliation(s)
- Ciro Esposito
- 1 Department of Translational Medical Sciences, Federico II University of Naples , Italy
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Maillet OP, Garnier S, Dadure C, Bringuier S, Podevin G, Arnaud A, Linard C, Fourcade L, Ponet M, Bonnard A, Breaud J, Lopez M, Piolat C, Sapin E, Harper L, Kalfa N. Inguinal hernia in premature boys: should we systematically explore the contralateral side? J Pediatr Surg 2014; 49:1419-23. [PMID: 25148751 DOI: 10.1016/j.jpedsurg.2014.01.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/21/2014] [Accepted: 01/24/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Bilateral surgery has been largely advocated in premature boys with unilateral inguinal hernia owing to the high incidence of contralateral patent processus vaginalis. Recently, the potential morbidity of herniotomy in low birth-weight babies and the progress in pediatric anesthesia questioned this attitude. This study aims to evaluate the incidence of contralateral metachronous hernia in a large series of premature boys and to compare the morbidity of preventive versus elective surgery. METHODS This retrospective multicenter analysis of 964 premature boys presenting with unilateral inguinal hernia operated from 1998 to 2012 included 557 infants who benefited from a unilateral herniotomy and 407 from a bilateral herniotomy (median follow-up 12months). RESULTS Contralateral metachronous hernia after unilateral surgery occurred in 11% (n=60) without significant difference according to the initial symptomatic side (9.5% on right vs 13% on left, p>0.05). Postoperative morbidity on the contralateral side was higher after preventive surgery than elective surgery with metachronous hernia (2.45% versus 0.9%, p=0.05) especially for secondary cryptorchidism (1% vs 0%, p=0.03). Despite the risk of metachronous incarcerated hernia, elective surgery did not increase the rate of testicular hypotrophy on the opposite side (0.7%, vs 0.7%, p>0.05). CONCLUSION Systematic bilateral herniotomy is unnecessary in almost 90% of patients and has a significant morbidity. Secondary surgery for metachronous hernia does not increase the risk of testicular lesion and even reduces the risk of secondary cryptorchidism. These results, along with the risk of hypofertility reported after bilateral surgery, may justify treating only the symptomatic side in premature boys.
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Affiliation(s)
- Olivier Pierre Maillet
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.
| | - Sarah Garnier
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France
| | - Christophe Dadure
- Département de Réanimation d'Anesthésie Unité d'Anesthésie de Soins Continus Chirurgicaux Pédiatriques CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France
| | - Sophie Bringuier
- Département Médical d'Information, CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France
| | - Guillaume Podevin
- Département de chirurgie pédiatrique, Hôpital Mère-Enfant, CHU Nantes, Nantes, France
| | - Alexis Arnaud
- Département de chirurgie pédiatrique, CHU Rennes, Rennes, France
| | | | - Laurent Fourcade
- Département de chirurgie pédiatrique Hôpital Mère-enfant CHU Limoges, Limoges, France
| | - Michel Ponet
- Département de chirurgie pédiatrique, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Arnaud Bonnard
- Département de chirurgie pédiatrique urologie CHU Robert Debré, Paris, France
| | - Jean Breaud
- Département de chirurgie pédiatrique, CHU Lanval, Nice, France
| | - Manuel Lopez
- Département de chirurgie pédiatrique, CHU Saint Etienne, Saint Etienne, France
| | | | - Emmanuel Sapin
- Département de chirurgie pédiatrique, Hôpital d'Enfants, CHU Dijon, Dijon, France
| | - Luke Harper
- Département de chirurgie pédiatrique, CHU Felix Guyon, Saint Denis, Réunion, France
| | - Nicolas Kalfa
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France
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Wang JH, Zhang W, Tou JF, Huang SJ, Liu WG, Xiong QX, Zhao ZY. Incidence of pediatric metachronous contralateral inguinal hernia in children aged ≥1 year. World J Pediatr 2012; 8:256-9. [PMID: 22886200 DOI: 10.1007/s12519-012-0367-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The management of the contralateral asymptomatic side when a child with initial unilateral inguinal hernia undergoes herniorrhaphy continues to be controversial. Age less than 6 months at initial herniorrhaphy is considered as a high risk factor of the occurrence of metachronous contralateral inguinal hernia (MCIH). We performed herniorraphy for patients ≥1 year with initial unilateral hernia at one-day-set outpatient-surgery department without any intervention of contralateral groin. In this study, we reviewed the characteristics of development of MCIH in this condition and discuss the management strategies of MCIH. METHODS The subjects of this study were children who were treated at our outpatient-surgery department from January 2006 to December 2006. A total of 2129 patients with initial unilateral hernia and aged ≥1 year underwent an ipsilateral herniorhhaphy only. Patients were followed up for the development of MCIH to 60 months. The Chi-square test was used for intergroup comparison, a level of P<0.05 was considered as statistically significant. RESULTS Among these children 1341 (63.0%) were obtained 60 months follow-up data, 1146 (85.5%) were boys and 195 (14.5%) were girls. MCIH developed in 70 (5.2%) patients, 61 were boys and 9 were girls. In 570 patients aged 12-23 months, 43 developed MCIH (7.5%); in 564 patients aged 24-59 months, 21 developed MCIH (3.7%); and in 207 patients ≥60 months, 6 patients developed MCIH (2.9%), the difference between these groups was highly significant (P=0.004). In male patients, 30 right-sided MCIHs occurred after 423 initial left-sided herniorrhaphies (7.1%) and 31 left-sided MCIHs occurred after 723 initial right-sided herniorrhaphies (4.3%), difference between these two groups was significant (P=0.041). Seventy-seven percent of the MCIHs occurred within 1 year, 94% occurred within 2 years after initial herniorraphy. CONCLUSIONS As the overall incidence of MCIH in patients aged ≥1 year was 5.2%, routine contralateral groin exploration is not suggested. Transinguinal laparoscopy could be considered as an alternative of conventional "wait and see" policy, especially in patients less than 2 years or left-sided initial unilateral inguinal hernia. If "wait and see" policy is adopted, patients should be closely followed up for 2 years.
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Affiliation(s)
- Jin-Hu Wang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Systematic review for paediatric metachronous contralateral inguinal hernia: a decreasing concern. Pediatr Surg Int 2011; 27:953-61. [PMID: 21604078 DOI: 10.1007/s00383-011-2919-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Controversy still surrounds the treatment of the asymptomatic inguinal region in paediatric patients with a unilateral inguinal hernia. The concern is the development of a future metachronous contralateral inguinal hernia (MCIH) and therefore the need for a second operation. Our aim was to provide a current systematic review of the evidence for routine contralateral exploration, and identify potential at-risk groups. METHODS Comprehensive review of the literature utilising broad search terms to identify all relevant publications. Precise inclusion and exclusion criteria to identify studies that included paediatric unilateral inguinal hernia repair without routine contralateral exploration. DATA ANALYSIS Chi-square with Yates' correction or a Fisher's exact test as appropriate. Numbers needed to treat (NNT) calculated with 95% confidence intervals. RESULTS A total of 7,130 titles and abstracts were screened and 61 studies included with data on 49,568 paediatric patients with a unilateral inguinal hernia fulfilling the inclusion criteria. 2,857 of these patients later developed a MCIH, revealing an overall risk is 5.76% (95% CI: 5.55-5.97%). The NNT for a MCIH is 18 (95% CI: 16.8-18) with 18 contralateral exploration required for the prevention of one MCIH. Patients <6 months at the time of the initial intervention were more likely to develop a MCIH; 183/1,470 (<6/12) versus 144/2,044 (≥6/12), P < 0.0001. As were patients with an original left-sided hernia; 815/6,739 versus 865/12,615, P < 0.0001. The NNTs for both of these groups were 9. There was no association with the gender of the patient; 888/14,480 (♂) versus 268/4,206 (♀), P = 0.37. CONCLUSIONS There is insufficient evidence to support the routine contralateral inguinal exploration in all paediatric patients presenting with a unilateral inguinal hernia. However, with patients presenting with an originally left-sided hernia or who are less than 6 months old, a parental discussion should occur about the possible benefits and risks of contralateral exploration.
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Karabulut B. One surgeon experiences in childhood inguinal hernias. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:50-3. [PMID: 22066100 PMCID: PMC3204552 DOI: 10.4174/jkss.2011.81.1.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 04/03/2011] [Indexed: 11/30/2022]
Abstract
Purpose In this manuscript we report one pediatric surgeon's experience in childhood inguinal hernia repair. Methods From 2005 to 2008, 402 children with inguinal hernias were operated on by one surgeon. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients. Results The ages ranged from 20 days to 16 years with a male-to-female ratio of 2.5:1. 64.9% right, 27.1% left, and 7.9% bilateral hernias. Hydroceles were present in 6.2% assosiated hernias. Incarceration occurred in 8.7% of children. An opposite-side hernia developed in 5.7%. 5.3 percent of patients with a hernia repair on the right side later developed a hernia on the left side, and 8.2% of patients with a hernia repair on the left side later developed one on the right side. 4.5 percent of all male patients in this series and 8.6% of female patients developed an opposite-side hernia. While overall recurrence rate was 1.2%, our recurrence rate was 0.25%. There was a 0.24% wound infection rate, and 1 (0.24%) testicle was atrophic at follow-up. Conclusion In this study, in the recurrence of childhood hernia, the general surgeon's intervention was the prominent cause. It is suggested by the study that inguinal hernias on the contralateral side becomes symptomatic within the first six months following initial operation.Therefor, close observation is needed in that time.
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Affiliation(s)
- Bilge Karabulut
- Department of Pediatric Surgery, Ankara Education and Research Hospital, Ankara, Turkey
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