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Michler V, Elrod J, Wingtes K, Trah J, Reinshagen K, Boettcher M. Should the processus vaginalis sac be opened or closed in pediatric herniotomy? A two-center cohort study. Pediatr Surg Int 2022; 38:1165-1169. [PMID: 35666281 DOI: 10.1007/s00383-022-05145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inguinal hernia repair is one of the most common operations in children. To improve outcome, several techniques are used. However, it has not been established if the open or the closed hernia sac preparation technique is superior in (premature) neonates and older children. METHODS Retrospective study including all cases of inguinal hernia repair in children at two large centers. Demographic data and outcome parameters including procedure time and intra as well as postoperative complications were evaluated. To compare open vs. closed hernia sack preparation, cases with secondary open preparation were excluded and propensity score matching was performed. Regression analysis was used to determine factors affecting operative time and recurrence rate. RESULTS In total 2476 cases of inguinal hernia repair were identified. After exclusion of direct hernias as well as revision cases, 2257 cases were analyzed. Overall mean operative time was 25.8 min. Intraoperative complications occurred in 0.1% and. postoperative complications occurred in 3.0% of all cases, the most frequent postoperative complication being recurrence (1.7%). Closed preparation technique resulted in significantly faster procedure time and lower recurrence rates in premature neonates and older children compared to the open hernia sac preparation technique. Operative technique, prematurity, gender and training of the surgeon are highly associated with operative time, whereas operative technique is the main factor affecting recurrence rate. CONCLUSIONS It appears that closed hernia sack preparation is superior to open regarding speed and recurrence. This was true for premature neonates, neonates and older children. All other outcome parameters including intra- and postoperative complications were similar. Thus, we recommend to use the closed preparation technique whenever possible.
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Affiliation(s)
- Veronika Michler
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kristofer Wingtes
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Trah
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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Kart Y, Ozturk C. Comparison of Inguinal Herniotomies with and Without Opening the External Oblique Aponeurosis in Children Above the Age of Two. Niger J Clin Pract 2022; 25:33-36. [PMID: 35046192 DOI: 10.4103/njcp.njcp_82_21] [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: 11/04/2022]
Abstract
Background Mitchell-Banks technique (MBT), in which inguinal canal is not opened, usually used in inguinal hernia repair in children under 2 years of age. The majority of pediatric surgeons tend to open the inguinal canal while performing inguinal hernia surgery in children over 2 years of age, called as modified Ferguson herniotomy (FH). Aims This study aimed to compare early and late complications of the MBT and FH in over 2 years of age patients who underwent inguinal hernia surgery. Patients and Methods We retrospectively reviewed the medical records of all children between 2 and 16 years old who underwent inguinal herniotomy procedure using the MBT and FH between January 2013 and December 2019. Patients were evaluated in terms of demographic data, early and late complications. Results This study included 834 children. Of these, 379 (44.8%) were operated on by an FH with opening the inguinal canal (Group 1), and 455 (55.2%) by MBT superficially to the external ring (Group 2). There were 68 (17.9%) females and 311 (82.1%) males in group 1, while there were 151 (33.2%) females and 304 (66.8%) males in group 2. Early complications were wound infection (1.1% in the group 1 vs. 1.3% in the group 2, P = 1.00) and scrotal hematoma (1.3% vs. 1.8%, P = 0.89). Late complications included recurrence (1.6% in the group 1 vs. 1.8% in the group 2, P = 0.12), undescended testis (2.1% vs. 0.7%, P = 0.71), testicular atrophy (1.5% vs. 0.4%, P = 0.79), and hydrocele (1.9% vs. 1.8%, P = 0.87). There was no statistically significant difference in terms of early and late complications ratio between two groups. Conclusion This study showed that inguinal hernia repair performed without opening the inguinal canal in children older than 2 years do not lead to an increase in complications. In this respect, MBT can be used as a simple and safe procedure in older children.
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Affiliation(s)
- Y Kart
- Department of Pediatric Surgery, Süleyman Demirel University Medical Faculty, Isparta, Turkey
| | - C Ozturk
- Kartal Dr. Lütfi Kırdar City Hospital, Clinics of Pediatric Surgery, İstanbul, Turkey
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Marte A, Caldamone AA, Aguiar LM. The history of the pediatric inguinal hernia repair. J Pediatr Urol 2021; 17:485-491. [PMID: 34134946 DOI: 10.1016/j.jpurol.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
The history of inguinal hernia repair is a rich one. For centuries, hernia healers, doctors, anatomists, surgeons and quacks have been devoted to this pathology that has afflicted mankind throughout its evolution. The development of surgical correction mainly focused on adult pathology, with treatments that often involved the loss of the testis. Hernia management in children, however, also dates from antiquity. Described as a swelling on the surface of the belly in ancient papyri, it was treated with tight bandages by the early physicians of Alexandria. For centuries, conservative treatment had been used for the child using primordial trussess, many prayers, and often pagan rituals as the arboreal passage of children described by Marcello of Bordeaux, doctor of the Emperor Theodosius I (347-395 AD), reserving medical intervention only for cases of strangulation in which only reduction was attempted. The middle ages were characterized by an increase in cultural and scientific exchange, during which the first comprehensive surgical textbooks and atlases were written. Different approaches to the inguinal hernia were not taught and passed down through generations of surgeons. The modern era brought a better understanding of the inguinal anatomy, which led to surgical techniques associated with less post-operative complications. Today, the pediatric inguinal hernia repair is one of the most common pediatric operations performed. It is considered a safe procedure with very low complication rate.
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Affiliation(s)
- Antonio Marte
- Pediatric Surgery, Università Della Campania Luigi Vanvitelli, Naples, Italy.
| | - Anthony A Caldamone
- Pediatric Urology, Brown University and Hasbro Children's Hospital, Providence, RI, USA.
| | - Liza M Aguiar
- Pediatric Urology, Brown University and Hasbro Children's Hospital, Providence, RI, USA.
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Ahmad HM, Naumeri F, Saud U, Butt G. Comparison of Ferguson and Gross herniotomy with Mitchell Banks' herniotomy in boys older than two years. Pak J Med Sci 2020; 37:40-44. [PMID: 33437248 PMCID: PMC7794118 DOI: 10.12669/pjms.37.1.3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & Objective In children younger than two years, most surgeons perform the inguinal herniotomy superficially through the external ring, a technique known as Mitchell-Banks' Herniotomy (MBH) while in older children, commonly Ferguson and Gross Herniotomy (FGH) is performed which involves opening of inguinal canal. Our aim was to compare the FGH and MBH in terms of recurrence in boys with inguinal hernia. Methods Boys with inguinal hernia presenting to Pediatric Surgery, Mayo Hospital Lahore from Dec 2016 to January 2018 were included in the study, if older than two years and younger than 14 years and without palpable deep ring (2 cm or more in width) or strangulation of inguinal hernia or malnutrition. They were randomly allocated in 2 groups after obtaining informed consent from parents, and underwent MBH (Group-A) and FGH (Group-B). Children were called for follow up after 1 week and at 6 months to assess for recurrence. Results Total 260 patients with inguinal hernia were enrolled (NCT: 03392636). The mean age of boys in Group-A was 5.2±3.0 years and in Group-B was 5.9±3.1 years. Mean operating time in Group-A (26.65±3.22 minutes) was longer than Group-B (15.92±4.22 minutes), and scrotal oedema was noted in 38 (29.2%) cases in Group-A, while 7 (5.4%) cases in Group-B. Testicular atrophy was noted in one patient of Group-B. Recurrence occurred in 1(0.8%) patient in Group-A, and in 8(6.2%) patients in Group-B (p-value 0.018). Conclusion Mitchell-Banks' herniotomy has lower recurrence rate than Ferguson and Gross Herniotomy in boys older than two years.
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Affiliation(s)
- Hafiz Mahmood Ahmad
- Dr. Hafiz Mahmood Ahmad, MBBS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan
| | - Fatima Naumeri
- Dr. Fatima Naumeri, MCPS, FCPS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan
| | - Usama Saud
- Dr. Usama Saud, MBBS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan
| | - Ghazala Butt
- Dr. Ghazala Butt, MD, PhD. Department of Dermatology, King Edward Medical University/Mayo Hospital Lahore, Pakistan
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Aihole JS. The demographic profile and the management of infantile inguinal hernia: a 3-year’s review. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00037-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Inguinal hernia in neonates and infants including children is as a result of failure of processes vaginalis to close. Once diagnosed, it should be promptly repaired on elective basis to prevent possible risk of bowel incarceration. The purpose of this study was to evaluate the clinical profile, management, and outcome of infantile inguinal hernia.
Methods
Aim of this prospective clinical study was to clinically evaluate the infants with clinical diagnosis of inguinal hernia admitted in our tertiary child care institute from January 2014 to December 2017 over a period of three years. The design of this study was to assess the clinical profile, management and outcome of infantile inguinal hernia. Study was conducted in a tertiary care neonatal and paediatric referral centre in southern India. Infants less than 1 year including neonates were selected for this study on the basis of inclusion and exclusion criteria. The maximum follow-up period was 5 years.
Results
A total of 118 infants admitted with clinical diagnosis of inguinal hernia were included in the present study. They were grouped as per their clinical diagnosis and age on admission into two groups; 0 to 6 months as group I and more than 6 months to 12 months as group II. All of them underwent surgical repair as soon as diagnosed. Overall survival rate was 100%. There was no operative mortality 0/118 (0%). Rate of recurrence was 0.034% without any surgical site infections.
Conclusion
Early surgical intervention in the form of inguinal herniotomy is the most appropriate management of inguinal hernia in infants including the neonates as soon as diagnosed on elective basis.
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Igwe AO, Talabi AO, Adisa AO, Adumah CC, Ogundele IO, Sowande OA, Adejuyigbe O. Comparative Study of Laparoscopic and Open Inguinal Herniotomy in Children in Ile Ife, Nigeria: A Prospective Randomized Trial. J Laparoendosc Adv Surg Tech A 2019; 29:1609-1615. [DOI: 10.1089/lap.2019.0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Arua Obasi Igwe
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Ademola O. Talabi
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Adewale O. Adisa
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Collins C. Adumah
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Ibukun O. Ogundele
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Oludayo A. Sowande
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
| | - Olusanya Adejuyigbe
- Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Osun, Nigeria
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Acer-Demir T, Ekenci BY, Özer D, Turanoğlu MA, Haberal KC, Bilgin EB, Hiçsönmez A. Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience. Urology 2018; 112:155-160. [DOI: 10.1016/j.urology.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/25/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Askarpour S, Peyvasteh M, Sherafatmand S. COMPARISON BETWEEN INGUINAL HERNIOTOMIES WITH AND WITHOUT INCISING EXTERNAL OBLIQUE APONEUROSIS: A RANDOMIZED CLINICAL TRIAL. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 30:187-189. [PMID: 29019559 PMCID: PMC5630211 DOI: 10.1590/0102-6720201700030006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 06/06/2017] [Indexed: 11/22/2022]
Abstract
Background: Inguinal herniotomy is the most common surgery performed by pediatric surgeons. Aim: To compare the results and complications between two conventional methods of pediatric inguinal herniotomy with and without incising external oblique aponeurosis in terms of recurrence of hernia and other complications. Methods: This one blinded clinical trial study was conducted on 800 patients with indirect inguinal hernia. Inclusion criterion was children with inguinal hernia. The first group underwent herniotomy without incising external oblique aponeurosis and second group herniotomy with incising external oblique aponeurosis. Recurrence of hernia and other complications including ileoinguinal nerve damage, hematoma, testicular atrophy, hydrocele, ischemic orchitis, and testicular ascent were evaluated. Results: Recurrence and other complications with or without incising external oblique aponeurosis had no significant difference, exception made to hydrocele significantly differed between the two groups, higher in the incision group. Conclusion: Herniotomy without incising oblique aponeurosis can be appropriate choice and better than herniotomy with incising oblique aponeurosis. Children with inguinal herniotomy can be benefit without incising oblique aponeurosis, instead of more interventional traditional method.
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Affiliation(s)
- Shahnam Askarpour
- Ahvaz Jundishapur University of Medical Sciences, Department of Pediatric Surgery, Imam Khomeini Hospital, Ahvaz, Khouzestan, Iran
| | - Mehran Peyvasteh
- Ahvaz Jundishapur University of Medical Sciences, Department of Pediatric Surgery, Imam Khomeini Hospital, Ahvaz, Khouzestan, Iran
| | - Shaghayegh Sherafatmand
- Ahvaz Jundishapur University of Medical Sciences, Department of Pediatric Surgery, Imam Khomeini Hospital, Ahvaz, Khouzestan, Iran
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Tuncer AA, Peker T, Acar MB, Embleton DB, Cetinkursun S. A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study. Pak J Med Sci 2017; 33:363-368. [PMID: 28523038 PMCID: PMC5432705 DOI: 10.12669/pjms.332.12487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effect of inguinal operations performed with a modified Ferguson technique upon testicular volume and blood flow. METHODS This study involved 23 children receiving surgery for inguinal hernia, hydrocele, and cord cyst. This was a prospective study performed between April 2016 and June 2016 in a medical faculty pediatric surgery unit. The color Doppler ultrasound (CDUS) was used to assess testicular volume and blood flow before and after a modified Ferguson technique surgery. The pre- and post operative testicular volume and blood flow were compared with the contralateral testes. SPSS software was used to statistically analyze the data arising; the Mann-Whitney U test and Friedman test were used to compare samples, and P<0.05 was accepted as statistically significant. RESULTS Preoperative and postoperative testicular volumes were not statistically different when compared to contralateral testes. In patients with right sided inguinal pathology, testicular blood flow on the right side was significantly lower than that on the left side (P=0.023). The testicular blood flow was not statistically different compared with the contralateral testes during the first week evaluation and first month evaluation. The blood flow, probably reduced due to the pressure caused by inguinal pathology, was normalized through surgery. CONCLUSIONS The modified Ferguson technique do not change the testes volume and blood flow.
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Affiliation(s)
- Ahmet Ali Tuncer
- Dr. Ahmet Ali Tuncer, Assistant Professor, Department of Pediatric Surgery, Afyon Kocatepe University, Medical Faculty, Afyonkarahisar, Turkey
| | - Tamer Peker
- Dr. Tamer Peker, MD, Department of Pediatric Surgery, Afyon Kocatepe University, Medical Faculty, Afyonkarahisar, Turkey
| | - Mehtap Berke Acar
- Dr. Mehtap Berke Acar, Assistant Professor, Department of Radiology, Department of Pediatric Surgery, Afyon Kocatepe University, Medical Faculty, Afyonkarahisar, Turkey
| | - Didem Baskin Embleton
- Dr. Didem Baskin Embleton, Assistant Professor, Afyon Kocatepe University, Medical Faculty, Afyonkarahisar, Turkey
| | - Salih Cetinkursun
- Prof. Dr. Salih Cetinkursun, Afyon Kocatepe University, Medical Faculty, Afyonkarahisar, Turkey
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