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Kılıç S. Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children. Ann R Coll Surg Engl 2024. [PMID: 39051789 DOI: 10.1308/rcsann.2024.0058] [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: 07/27/2024] Open
Abstract
INTRODUCTION Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method. METHODS Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared. RESULTS The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time (p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients. CONCLUSIONS PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.
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Affiliation(s)
- S Kılıç
- Private Gebze Yuzyil Hospital, Gebze, Kocaeli, Turkiye
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2
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Öberg S, Sæter AH, Rosenberg J. The inheritance of groin hernias: an updated systematic review with meta-analyses. Hernia 2023; 27:1339-1350. [PMID: 36443569 DOI: 10.1007/s10029-022-02718-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this systematic review was to assess the inheritance of groin hernias. METHODS The primary outcome was to assess the inheritance based on the family history of groin hernias. We included studies that reported family history in patients with groin hernias, assessed the development of groin hernias in patients with a positive family history, or assessed the development of groin hernias in twins. Searches were conducted in PubMed, EMBASE, and Cochrane CENTRAL in November 2021. Results were synthesized narratively and with meta-analyses. RESULTS Twenty-two studies with unique participants were included. While two twin studies did not show convincing results of a genetic origin in children, database studies with low risk of bias showed that a positive history in parents or siblings increased the risk of inguinal hernia in children, and the risk was highest between mothers and daughters and between sisters. In adults, patients with inguinal hernia had higher odds of having a positive family history compared with patients without groin hernia (odds ratio 5.3, 95% confidence interval 3.3-8.7), and a nationwide study found the highest risk of inguinal hernia repair when a sister had been repaired compared with a brother. This study also found that having a sibling repaired for a groin hernia increased the risk of femoral hernia repair. CONCLUSION Despite studies being heterogeneous, there is overwhelming evidence that a positive family history is a risk factor for developing inguinal hernia in both children and adults, seemingly with a pronounced female-female inheritance pattern.
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Affiliation(s)
- S Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - A H Sæter
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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The relationship between contralateral patent processus vaginalis and metachronous contralateral inguinal hernia in children with unilateral inguinal hernia: a prospective observational study. Hernia 2022; 26:1161-1168. [PMID: 35821302 DOI: 10.1007/s10029-022-02638-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Laparoscopic contralateral patent processus vaginalis (CPPV) repair in children is debatable due to the high CPPV rate, but low metachronous contralateral inguinal hernia (MCIH) rate. We conducted this study to find risk factors for MCIH. METHOD We conducted a prospective, observational trial with patients recruited from Shanghai Children's Hospital. Eligible participants were patients under 16 years old with unilateral inguinal hernia whose parents did not opt for simultaneous CPPV repair. The subjects were followed for 24 to 34.1 months. Patients who developed MCIH were analyzed to identify the relationship between CPPV and MCIH. RESULTS Between October 17, 2018, and July 31, 2019, we included 184 patients and 182 completed follow-up. MCIH occurred in ten patients, of which 7 (7.53%) had CPPV and three (3.37%) had no CPPV. Univariate analysis showed that age (p = 0.025, OR = 0.938) and CPPV diameter (p = 0.003, OR = 1.783) were related to the development of MCIH. In multivariate analysis, only diameter of CPPV (p = 0.008, OR = 1.411) was associated with MCIH. The receiver operating characteristic (ROC) curve was used to test, and it was found that when the diameter of CPPV was greater than 4 mm, the Youden index was the highest, with a specificity of 62.8% and a sensitivity of 100%. CONCLUSION The incidence of MCIH was not statistically higher in patients with CPPV compared with those without CPPV, so there is no indication for routine CPPV repair. The risk of MCIH development increases with CPPV diameter. 4 mm is the optimal cutoff point. Large CPPVs (> 4 mm) could be treated to prevent future hernias. TRIAL REGISTRATION The Chinese Clinical Trial Registry ( www.chictr.org.cn ), number ChiCTR2000041307.
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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: 10] [Impact Index Per Article: 2.5] [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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Danielson J, Pakkasjärvi N, Högberg N. Percutaneous hernia repair in children: Safe to introduce. Scand J Surg 2020; 110:380-385. [PMID: 32693714 DOI: 10.1177/1457496920918151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE In 2014 we introduced percutaneous internal ring suture as an alternative to open surgery for the treatment of inguinal hernia. This study aims to evaluate the introduction of the procedure at our institution. METHODS In total, 100 consecutive patients operated with percutaneous internal ring suture were compared with 100 consecutive patients operated with open surgery. The patients were operated from August 2014 until November 2017. Patient demographics, clinical history, operative time, time in theater, and postoperative complications were extracted from charts. RESULTS The mean operative time for percutaneous internal ring suture was 26.54 min and for open surgery 39.94 min, P < 0.0001. The total mean operative theater time for percutaneous internal ring suture was 108.95 min and for open surgery 118.4 min, P = 0.0343. During follow-up, two percutaneous internal ring sutures were operated for recurrent hernia. In the open surgery-group, three patients were operated for recurrent hernia, three for secondary testicular retention, and three for metachronous contralateral hernia. CONCLUSIONS Even when established as a new technique, the percutaneous internal ring suture procedure is safe and results in shorter operative time and shorter theater time compared to open surgery.
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Affiliation(s)
- Johan Danielson
- Department of Pediatric Surgery, Akademiska Sjukhuset, Uppsala, S-75185, Sweden
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, Akademiska Sjukhuset, Uppsala, Sweden.,Department of Pediatric Surgery, Children's Hospital, Turku University Hospital, Turku, Finland
| | - Niclas Högberg
- Institution of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Pediatric Surgery, Akademiska Sjukhuset, Uppsala, Sweden
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Abstract
Inguinal hernia is a common problem affecting infants in the NICU. As a group, preterm infants have the highest incidence of inguinal hernia and this risk increases as gestational age decreases. The etiopathologic factors leading to the development of an inguinal hernia are not clear and interventions to alter these factors have not been thoroughly investigated. Diagnosis of an inguinal hernia is often straightforward, but occasionally it may be difficult to determine if the hernia is strangulated or simply obstructed. Rarely, investigative modalities, such as ultrasonography, may be needed to rule out other potential causes. The ideal timing of surgical repair in this population is unknown and complicated by comorbid conditions and limited randomized controlled trials. During surgery, the choice of regional versus general anesthesia requires a team-based approach and studies have found that greater clinical experience is associated with lower morbidity. The techniques of hernia surgery range from open to laparoscopic repair and have been investigated in small prospective studies, while larger databases have been used to analyze outcomes retrospectively.
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Gollu G, Ates U, Bahadir K, Ergun E, Yagmurlu A, Cakmak M, Aktug T, Dindar H, Bingol-Kologlu M. Transinguinal laparoscopic evaluation of contralateral side during unilateral inguinal hernia repair for children. J Pediatr Urol 2019; 15:561.e1-561.e6. [PMID: 31383517 DOI: 10.1016/j.jpurol.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inguinal hernia repair is a common procedure in daily pediatric surgical practice. OBJECTIVES The present study was planned to find out whether transinguinal laparoscopic exploration (TILE) of the contralateral groin is effective in reducing the need of operation for contralateral metachronous inguinal hernia (CMIH) in children. STUDY DESIGN Charts of 1103 children who underwent inguinal hernia repair between 2006 and 2016 were retrospectively analyzed. Eighty-eight children with bilateral hernia at the presentation were excluded, and 705 patients whose parents could be contacted by phone to get the latest information about children's condition were included in the study. RESULTS Of the 705 children with unilateral inguinal hernia repair, 362 (51.4%) and 343 (48.6%) of them had right-sided and left-sided inguinal hernia, respectively. Transinguinal laparoscopic exploration was performed in 479 of the 705 children with unilateral hernia and a hernia or contralateral patent processus vaginalis (PPV) was found and ligated in %28.3 (n = 136) of them. Mean follow-up time was 60 ± 36 months. Fifteen (4.3%) of 479 patients who had TILE and 31 (13.6%) of 226 the patients who did not have TILE developed CMIH. When the videos of 15 patients who developed CMIH were reviewed, overlooked PPV was found in 10 (3.3%) patients who had TILE during early phases of institutional learning curve. DISCUSSION AND CONCLUSIONS TILE of the contralateral side during pediatric inguinal hernia repair is a simple and effective method to evaluate contralateral PPV. This approach clearly and significantly reduces the need of operation for a metachronous hernia at a later date.
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Affiliation(s)
- G Gollu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - U Ates
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
| | - K Bahadir
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - E Ergun
- Sami Ulus Children's Hospital, Department of Pediatric Surgery, Ankara, Turkey
| | - A Yagmurlu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - M Cakmak
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - T Aktug
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - H Dindar
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - M Bingol-Kologlu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
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Jo HU, Yoo DS, Park J, Park HS, Shin HB, Woo SH. Independent risk factors for contralateral patent processus vaginalis undetected by pre-operative ultrasonography in boys with unilateral inguinal hernia. Pediatr Surg Int 2019; 35:591-595. [PMID: 30729303 DOI: 10.1007/s00383-019-04444-x] [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: 01/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Many trials have been done to make sure probability of metachronous contralateral side hernia (MCH) and contralateral patent processus vaginalis (CPPV). But the necessity of contralateral side exploration is still on debate. The aim is to investigate the risk factors for the consideration of contralateral examination on operation. MATERIALS AND METHODS The study was designed as retrospectively. Patients with unilateral inguinal hernia from January 2010 to May 2015 were enrolled. Pre-operative ultrasonography was done in all patients. Patients with obvious contralateral side hernia on pre-operative US were excluded. The presence of CPPV was evaluated by transinguinal laparoscopy during the operation. RESULTS In univariate analysis, hernial sac size only shows difference (P value: 0.001). The others, location of the hernia, age at surgery, gestational age (preterm), low birth weight and parent's age, did not show statistically significant differences. Multivariate analysis also demonstrates CPPV is more common in patients with large hernial sac (Odds ratio: 2.727, 95% confidence interval 1.495-4.974, P value: 0.001). CONCLUSION We propose that surgeons should consider contralateral evaluation during operation in case with large ipsilateral hernial sac, although CPPV was not detected by pre-operative US.
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Affiliation(s)
- Hyun-Uk Jo
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Dae Seon Yoo
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Hyun Sik Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Hyun Bin Shin
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Seung Hyo Woo
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea.
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Valioulis I, Papageorgiou I, Ioannidou D. The clinical significance of an incidentally detected open internal inguinal ring. J Pediatr Urol 2019; 15:185.e1-185.e5. [PMID: 30709588 DOI: 10.1016/j.jpurol.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/25/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE An open internal inguinal ring (IIR) may be discovered incidentally either in the context of correcting pathology involving the contralateral side or at the time of surgical exploration for reasons unrelated to a patent processus vaginalis (PPV). The aim of this study is to determine the evolution of an incidentally encountered open IIR in patients undergoing laparoscopy for reasons not associated with unilateral inguinal hernia or cryptorchidism. MATERIALS AND METHODS The authors conducted a prospective study of all patients who underwent laparoscopic surgery in the department of pediatric surgery at Agios Loukas hospital between 2004 and 2013 for various indications. Patients operated for inguinal hernia and cryptorchidism were excluded. During this period, 572 patients underwent laparoscopy for reasons not related to PPV. The median age at time of initial laparoscopy was 9,4 years (range 2 days-16 years). The IIRs were always inspected. No attempt was made to repair the open IIRs, as they were asymptomatic. Parents were informed after the operation, and instructions were given to inform us, in case that inguinal hernia symptoms manifested. The duration of the follow-up was 4 years. RESULTS Among these 572 patients, 39 patients with 44 open IIRs were found (6,82%). From the 39 patients, 35 were male and four were female; 22 had a right open IIR, 12 had a left one, and five of them a bilateral open IIR. The median age was 7,82 years (3-14 years). Four patients were lost during follow-up. Of the remaining 35 patients with 40 open IIRs, four developed an inguinal hernia (11,43%) and were operated on with laparoscopically assisted (subcutaneous endoscopically assisted ligation [SEAL]) technique at the time of diagnosis. The study results are demonstrated on Fig. 1. DISCUSSION The percentage of an incidentally discovered open IIR in this study is lower in comparison with studies including patients with PPV pathologies. There is a possibility, in those patients, of underlying pathology which can affect both sides. It is also lower in comparison with previous studies including younger patients. However, gender and side predominance is in accordance with most published studies. In this study group, the possibility of developing a symptomatic hernia from an asymptomatic open IIR is rather small. CONCLUSIONS An incidentally discovered open IIR in patients without symptoms, excluding those with contralateral inguinal hernias or cryptorchidism, has relatively low chance of developing an inguinal hernia. Thus, the authors support the strategy of close follow-up in these patients.
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Affiliation(s)
- I Valioulis
- 1(st) Department of Pediatric Surgery, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Greece; Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece.
| | - I Papageorgiou
- 1(st) Department of Pediatric Surgery, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Greece
| | - D Ioannidou
- Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece
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Is contralateral inguinal exploration necessary in preterm girls undergoing inguinal hernia repair during the first months of life? Pediatr Surg Int 2018; 34:1151-1155. [PMID: 30120549 DOI: 10.1007/s00383-018-4334-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND To assess the need for contralateral surgical exploration in preterm girls with symptomatic unilateral inguinal hernia. METHODS The medical data of girls operated for inguinal hernia between 2004 and 2016 in a single pediatric surgery center were retrospectively collected. Preterm girls operated for unilateral hernia before 6 months of life were selected (55/517 cases) to assess the incidence and risk factors for contralateral metachronous inguinal hernia (CMIH). RESULTS CMIH was observed in 7% of cases (4 girls with a right inguinal hernia in 3 cases) at a mean age of 4.2 years. Only one case occurred early (3 months). Birth weight and term were comparable (1674 ± 620 g and 32 ± 5 WA without CMIH vs. 1694 ± 582 g and 33 ± 3 WA with CMIH). CONCLUSION Contralateral inguinal hernia is very rare and generally occurs several years after inguinal repair surgery in preterm girls, which should encourage practitioners to follow these children throughout childhood for the subsequent development of inguinal hernia. This study did not find any arguments in favor of systematic contralateral exploration in preterm girls.
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Kangwen C, Guihe W. Efficacy of Laparoscopic Percutaneous Extraperitoneal Closure for Unilateral Inguinal Hernia in Children and Significance of Simple Exploration Maneuver for Contralateral Patent Processus Vaginalis: A Retrospective Study. Am Surg 2018. [DOI: 10.1177/000313481808400527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) for unilateral inguinal hernia in children and effect of intraoperative laparoscopic exploration for finding contralateral patent processus vaginalis (CPPV) on prevention of the metachronous contralateral hernia (MCH). We retrospectively analyzed unilateral inguinal hernia ligation in children, which can be diveded into two groups: a total of 252 cases with open surgical ligation from January 2010 to December 2012 (open group), a total of 184 cases underwent laparoscopic percutaneous peritoneal hernia sac high ligation LPEC from January 2013 to March 2015 (LPEC group). Then, we observed postoperative complications, recurrence of hernia, and the postoperative MCH in the two groups and analyzed the influence factors of the MCH. In Open groups and LPEC groups, the complication incidences, respectively, were 4.4 and 1.6 per cent, having statistical difference ( P > 0.05), the average postoperative follow-up duration, respectively, were 42 months and 22 months, whereas the overall incidence of MCH, respectively, were 5.2 and 0.5 per cent ( P < 0.05). In the first 24 months follow-up time, the overall incidence of MCH, respectively, were 3.6 and 0 per cent. Laparoscopic evaluation was positive for CPPV in 67 cases. We found the prevalence of 56.1 per cent of CPPV in LPEC groups aged 0.6 to 2 years old, finding the incidence gradually decline with the increase of age, until 14.3 per cent to 10 to 12 years old group. Our study shows LPEC has proven efficacy in treatment of unilateral inguinal hernia in children, and routine laparoscopic exploration with this simple maneuver should be actively performed to observe CPPV in all chidren.
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Affiliation(s)
- Cheng Kangwen
- Department of Gastrointestinal Surgery, People's Hospital of Tongling City, Tongling, Anhui, People's Republic of China
| | - Wang Guihe
- Department of Gastrointestinal Surgery, People's Hospital of Tongling City, Tongling, Anhui, People's Republic of China
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Abstract
Laparoscopy is a safe and effective technique in the repair of inguinal hernias. This article describes the different laparoscopic herniorrhaphy technique, as well as controversial topics, such as premature infants, contralateral repair, and incarcerated hernias.
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Affiliation(s)
- Sophia Abdulhai
- Division of Pediatric Surgery, Akron Children's Hospital, One Perkins Square, Suite 8400, Akron, OH 44308, USA
| | - Ian C Glenn
- Division of Pediatric Surgery, Akron Children's Hospital, One Perkins Square, Suite 8400, Akron, OH 44308, USA
| | - Todd A Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital, One Perkins Square, Suite 8400, Akron, OH 44308, USA.
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Zhao J, Chen Y, Lin J, Jin Y, Yang H, Wang F, Zhong H, Zhu J. Potential value of routine contralateral patent processus vaginalis repair in children with unilateral inguinal hernia. Br J Surg 2016; 104:148-151. [PMID: 27778329 DOI: 10.1002/bjs.10302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/21/2016] [Accepted: 07/25/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND The development of laparoscopy as a means of evaluation and treatment of inguinal hernia in children has raised the question of whether simultaneous closure of a contralateral patent processus vaginalis (CPPV) is justified. The present study aimed to determine the rate of metachronous inguinal hernia (MIH) in children with CPPV. METHODS Children with unilateral inguinal hernia from two hospitals underwent either open or laparoscopic repair, and were followed up for MIH. The presence of CPPV was evaluated during laparoscopy and, if detected, the CPPV was closed. The relationship between CPPV and subsequent MIH was studied. RESULTS The study included children who had complete follow-up (90·0 per cent of those having open repair and 92·2 per cent of those undergoing laparoscopic repair). Of 2538 children who had open hernia repair, 62 (2·4 per cent) developed MIH (30 on the right side and 32 on the left; P = 0·015). Among 2855 children who underwent laparoscopic repair, a CPPV was identified and closed in 1469 (51·5 per cent). The rate of MIH after negative laparoscopic evaluation for CPPV was three of 2855 (0·1 per cent). There were no significant differences in the rate of CPPV between sexes and either the right or left side (P = 0·072 and P = 0·099 respectively). Ipsilateral recurrence was less frequent after laparoscopic repair: seven (0·2 per cent) versus 26 (1·0 per cent) for open repair (P < 0·001). CONCLUSION Laparoscopic inguinal hernia repair was associated with a lower recurrence rate than open repair. Routine repair of CPPV reduced the rate of subsequent MIH, but 21 CPPVs needed to be closed to prevent one MIH.
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Affiliation(s)
- J Zhao
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - Y Chen
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - J Lin
- Department of Paediatric Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Y Jin
- Department of Child Healthcare, Gulin Institute of Health, Ningbo, Zhejiang, China
| | - H Yang
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - F Wang
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - H Zhong
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
| | - J Zhu
- Department of Paediatric Surgery, Ningbo Women and Children's Hospital, Zhejiang, China
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Sasse T, Moehrlen U, Meuli M, Vuille-dit-Bille RN. Exploration of the contralateral side when operating for inguinal hernia in children for detection of bilateral hernation. Hippokratia 2016. [DOI: 10.1002/14651858.cd009352.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tom Sasse
- University of Zürich; Institute of Physiology; Zürich Switzerland
| | - Ueli Moehrlen
- University Children's Hospital of Zurich; Pediatric Surgery; Steinwiesstrase 75 Zürich Switzerland 8032
| | - Martin Meuli
- University Children's Hospital of Zurich; Pediatric Surgery; Steinwiesstrase 75 Zürich Switzerland 8032
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Abstract
The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic and groin problems. In this article we review the current technique, indications, benefits and complications of laparoscopy in diagnosis and management of various groin problems in children including undescended testes (non-palpable and palpable) and inguinal hernia.
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Affiliation(s)
- Himanshu Aggarwal
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
| | - Barry A Kogan
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
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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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Yang XD, Wu Y, Xiang B, Wong K, Pei J, Li FY. Ten year experience of laparoscopic repair of pediatric hydrocele and the long-term follow-up results. J Pediatr Surg 2015; 50:1987-90. [PMID: 26251367 DOI: 10.1016/j.jpedsurg.2015.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 06/10/2015] [Accepted: 07/01/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aims to assess the efficacy and safety of laparoscopic repair for pediatric hydroceles and its long-term follow-up results. METHODS We performed this procedure to 284 patients from 2002 to 2011 using our specially designed curved awl. The patent internal ring was enclosed and fixed under laparoscopy and fluid within the patent processus vaginalis was emptied by percutaneous needle aspiration. RESULTS The median operation time was 16minutes. Fifty-seven contralateral open internal rings were diagnosed during laparoscopic exploration and closed at the same time. During our 10-year follow-up only four kids had recurrence of moderate amount of fluid accumulation 1-3months after the surgery and 3 of them spontaneously resolved during the outpatient follow-ups. Only one of them was treated by percutaneous needle aspiration successfully. No abdominal viscera injury happened. CONCLUSIONS Laparoscopic hydrocele repair proved to be applicable and effective with satisfactory long-term results according to our experience.
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Affiliation(s)
- Xiao-Dong Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Yang Wu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Bo Xiang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China.
| | - Kenneth Wong
- Department of Medical Statistics, West China School of Public Health, Sichuan University, China
| | - Jiao Pei
- Department of Surgery, The University of Hong Kong, Hong Kong
| | - Fu-Yu Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
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Sumida W, Watanabe Y, Takasu H, Oshima K, Komatsuzaki N. Effects of insistent screening for contralateral patent processus vaginalis in laparoscopic percutaneous extraperitoneal closure to prevent metachronous contralateral onset of pediatric inguinal hernia. Surg Today 2015; 46:569-74. [DOI: 10.1007/s00595-015-1199-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/25/2015] [Indexed: 11/28/2022]
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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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Zhong H, Wang F. Contralateral metachronous hernia following negative laparoscopic evaluation for contralateral patent processus vaginalis: a meta-analysis. J Laparoendosc Adv Surg Tech A 2013; 24:111-6. [PMID: 24180355 DOI: 10.1089/lap.2013.0429] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To conduct a meta-analysis of contralateral metachronous inguinal hernia (CMIH) that originated from negative laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) in children who presented with a unilateral inguinal hernia and to determine the incidence of and factors associated with such a CMIH. MATERIALS AND METHODS A PubMed search was performed for all studies concerning laparoscopic repair or evaluation of inguinal hernia in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND ("inguinal hernia" OR "metachronous hernia") AND child*. Inclusion criteria included unilateral inguinal hernia in children, negative laparoscopic evaluation of CPPV, without history of contralateral inguinal surgery previously, and clearly reporting CMIH development or not. Editorials, letters, review articles, case reports, animal studies, and duplicate patient series were excluded. RESULTS Twenty-three studies comprising 6091 children with negative CPPV fulfilled the inclusion criteria and were included in the final analysis, of whom 80 (1.31%) subsequently presented with a CMIH. Subgroup analysis showed that CMIH incidence was lower through an umbilical approach than via an inguinal one (0.85% versus 1.78%, P=.009). As for the transinguinal approach, there was a CMIH incidence of 0.78% and 2.05%, respectively, for laparoscopy with a small angle (30° and 70°), whereas there was no CMIH development for that with a large angle (110°, 120°, and flexible). A high pneumoperitoneum pressure (>10 mm Hg, >12 mm Hg, and >14 mm Hg) was usually associated with a slightly higher CMIH incidence than a low one (≤10 mm Hg, ≤12 mm Hg, and ≤14 mm Hg), all without significant difference. CMIH incidence was slightly lower for using a broad CPPV definition than for using a narrow one (0.64% versus 1.35%, P=.183). CONCLUSIONS CMIH following negative laparoscopic evaluation for CPPV was a rare but possible phenomenon. Choosing the transumbilical approach, transinguinal laparoscopy with a large angle, low-pressure pneumoperitoneum, and broad CPPV definition would probably reduce the occurrence of such CMIHs.
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Affiliation(s)
- Hongji Zhong
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital , Ningbo, Zhejiang, China
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Zöller B, Ji J, Sundquist J, Sundquist K. Shared and nonshared familial susceptibility to surgically treated inguinal hernia, femoral hernia, incisional hernia, epigastric hernia, and umbilical hernia. J Am Coll Surg 2013; 217:289-99.e1. [PMID: 23870221 DOI: 10.1016/j.jamcollsurg.2013.04.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 03/24/2012] [Accepted: 04/02/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND The familial risk of abdominal wall hernia (AWH) is largely unknown. In addition, it is unknown whether inguinal hernia (IH), femoral hernia (FH), incisional hernia (INH), epigastric hernia (EH), and umbilical hernia (UH) share familial susceptibility. The aim of this nationwide study was to determine the familial risks of concordant AWH (same disease in proband and exposed relative) and discordant AWH (different disease in proband and exposed relative). STUDY DESIGN Data from the Swedish Multigeneration Register on individuals aged 0 to 78 years were linked to the Swedish hospital discharge register and the Swedish outpatient register for the period from 1964 to 2010. Standardized incidence ratios (SIRs) and 95% CIs for surgically treated IH (n = 209,814 cases), FH (n = 4,576), INH (n = 19,494), EH (n = 8,257), and UH (n = 22,761) were calculated for siblings of individuals with hernia compared with the siblings of unaffected individuals. The procedure was repeated for spouses. RESULTS All concordant and most discordant familial sibling risks were increased. Familial concordant SIRs for siblings were IH = 1.97 (95% CI, 1.94-1.99), FH = 3.40 (95% CI, 2.44-4.62), INH = 2.24 (95% CI, 2.04-2.46), EH = 5.57 (95% CI, 4.64-6.64), and UH = 3.61 (95% CI, 3.33-3.91). Concordant familial risks were higher than discordant risks. For example, when the proband sibling had IH, the discordant SIRs were FH = 1.74 (95% CI, 1.61-1.88), INH = 1.22 (95% CI, 1.16-1.28), EH = 1.30 (95% CI, 1.20-1.40), and UH = 1.35 (95% CI, 1.29-1.41). Concordant SIRs for spouses were lower: IH = 1.23 (95% CI, 1.20-1.26), FH = 0.97 (95% CI, 0.64-1.36), INH = 1.56 (95% CI, 1.41-1.71), EH = 1.70 (95% CI, 1.09-2.45), and UH = 1.31 (95% CI, 1.09-1.56). CONCLUSIONS Family history of surgically treated AWH is an important risk factor for surgical treatment of AWH. The 5 forms of AWH studied share familial susceptibility, but site-specific familial factors might exist. Several spouse risks were increased, suggesting the possibility of a nongenetic contribution to familial risks.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
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Kokorowski PJ, Wang HHS, Routh JC, Hubert KC, Nelson CP. Evaluation of the contralateral inguinal ring in clinically unilateral inguinal hernia: a systematic review and meta-analysis. Hernia 2013; 18:311-24. [PMID: 23963735 DOI: 10.1007/s10029-013-1146-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/28/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal. METHODS We searched MEDLINE, EMBASE, and Cochrane databases (1940-2011) using 'hernia' and 'inguinal' and either 'pediatric,' 'infant,' or 'child,' to identify studies of pediatric (age ≤21 years) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I(2) > 50 %, or Cochrane's Q p ≥ 0.10). RESULTS We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3 % (95 % CI 6.5-8.1 %). Laparoscopic examination identified CPP in 30 % (95 % CI 26-34 %). Lower age was associated with higher incidence of CPP (p < 0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9 % (95 % CI 0.5-1.3 %). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution. CONCLUSIONS The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients.
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Affiliation(s)
- P J Kokorowski
- Division of Urology, Children's Hospital Los Angeles, Institute of Urology, University of Southern California, 4650 Sunset Blvd., #114, Los Angeles, CA, 90027, USA,
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Aggarwal H, Kogan BA, Feustel PJ. One third of patients with a unilateral palpable undescended testis have a contralateral patent processus. J Pediatr Surg 2012; 47:1711-5. [PMID: 22974611 DOI: 10.1016/j.jpedsurg.2012.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/01/2012] [Accepted: 01/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the incidence and predictive factors associated with a contralateral patent processus vaginalis in boys with a unilateral palpable undescended testis. METHODS We retrospectively reviewed the records of 77 consecutive boys (median age, 15 months; range, 5 months to 17.7 years) who had undergone orchiopexy for a unilateral palpable testis. At inguinal orchiopexy, an 8F feeding tube and a 70° adult cystoscope lens were placed into the peritoneum through the hernia sac, and the contralateral internal ring was inspected. The clinical factors that might predict the presence of a contralateral patent processus vaginalis were determined. RESULTS The overall rate of a contralateral patent processus vaginalis was 34% in those with a significant ipsilateral hernia sac. After considering age, side, prematurity, location, and volume of the undescended testis, only the boys with a testis distal to the external ring compared with those with testes lying within the inguinal canal had statistically increased odds of a patent contralateral processus vaginalis (odds ratio, 3.1; 95% confidence interval, 1.08-9.08). CONCLUSION Approximately one third of boys with a unilateral palpable undescended testis will have a contralateral patent processus vaginalis as determined by transinguinal laparoscopy. The rate is higher (52%) if the undescended testis was distal to the external ring. Both the etiology and significance of this contralateral finding are unknown.
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Boo YJ, Han HJ, Ji WB, Lee JS. Laparoscopic hernia sac transection and intracorporeal ligation show very low recurrence rate in pediatric inguinal hernia. J Laparoendosc Adv Surg Tech A 2012; 22:720-3. [PMID: 22734890 DOI: 10.1089/lap.2012.0040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are many variable techniques for laparoscopic inguinal hernia repair in children. The aim of this study was to examine the feasibility of the laparoscopic hernia technique, which is based on the same surgical principles as conventional open herniotomy. SUBJECTS AND METHODS Between November 2008 and August 2011, 207 pediatric patients with inguinal hernia were included in this study under informed consent. All of the patients underwent the laparoscopic technique of sac transection and intracorporeal ligation. An asymptomatic contralateral patent processus vaginalis (cPPV) was repaired using the same method. Patients were routinely followed for 2 years. Perioperative complications and recurrence rate were evaluated. RESULTS In total, 202 patients were enrolled in the final analysis. The mean follow-up period was 12.5 months. The percentage of patients with cPPV was 39.2%. The mean operation time was 26 minutes for unilateral hernias and 34 minutes for bilateral hernias. One patient had a mild hematoma in the inguinal area in the immediate postoperative period, but it resolved spontaneously within 7 days. Recurrence and metachronous hernias have not been observed thus far. CONCLUSIONS Laparoscopic hernia sac transection and intracorporeal ligation can be a safe and effective alternative for conventional herniotomy.
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Affiliation(s)
- Yoon-Jung Boo
- Division of Pediatric Surgery, Korea University College of Medicine, Seoul, Korea.
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26
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Modified laparoscopic high ligation in treatment of inguinal hernial sac in infants: a report of 183 cases. ACTA ACUST UNITED AC 2011. [DOI: 10.3724/sp.j.1008.2011.00654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lin CD, Tsai YC, Chang SJ, Yang SS. Surgical Outcomes of Mini Laparoscopic Herniorrhaphy in Infants. J Urol 2011; 185:1071-6. [DOI: 10.1016/j.juro.2010.10.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Chia-Da Lin
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shang-Jen Chang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Stephen S. Yang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
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Chung KL, Leung MW, Chao NS, Wong BP, Kwok WK, Liu KK. Laparoscopic repair on asymptomatic contralateral patent processus vaginalis in children with unilateral inguinal hernia: A centre experience and review of the literature. SURGICAL PRACTICE 2011. [DOI: 10.1111/j.1744-1633.2010.00532.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Esposito C, Montinaro L, Alicchio F, Savanelli A, Armenise T, Settimi A. Laparoscopic treatment of inguinal hernia in the first year of life. J Laparoendosc Adv Surg Tech A 2010; 20:473-6. [PMID: 20367143 DOI: 10.1089/lap.2009.0323] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Laparoscopic inguinal hernia repair is rarely reported in the first year of life. In this article, we report our experience to emphasize the advantages of this procedure in this age range. PATIENTS AND METHODS In a 2-year period, we operated on 315 patients for unilateral inguinal hernia by using laparoscopy. Fifty of 315 patients (15.9%) had less than 1 year of age. This study focused on this group of 50 children (36 boys and 14 girls). The age range was 1-12 months (median, 6.7) with a median body weight of 5.5 kg (range, 3.7-9). As for a technical point of view, we used modified laparoscopic herniorraphy, according to the Montupet technique. After sectioning the sac distally to the ring, the periorifical peritoneum was closed by using a purse-string suture of a nonresorbable suture. RESULTS The median operating time was 22 minutes (range, unilateral, 7-30; bilateral, 12-42). All the procedures were performed in a day hospital setting. As for laparoscopic findings in 22 of 50 patients (44%), we found a contralateral patency of the processus vaginalis. In these 22 cases, we performed a bilateral herniorraphy. In 1 girl (2%), we found a coexistence of indirect hernia and a direct hernia on the right side. Both orifices were sutured in laparoscopy. We recorded only 1 minor complication (2%); a problem with needle extraction. With a minimum follow-up of 1 year, we have had only 1 recurrence (1.3%) on 73 herniorraphies performed. CONCLUSIONS We believe that laparoscopic repair of inguinal hernia in boys under 1 year of age by expert hands is a safe, effective procedure to perform. Its ability to simultaneously repair all forms of inguinal hernias, together with contralateral patencies, has cemented its role as a viable alternative to conventional repair.
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Affiliation(s)
- Ciro Esposito
- Department of Pediatrics, Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
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Clarke S. Pediatric inguinal hernia and hydrocele: an evidence-based review in the era of minimal access surgery. J Laparoendosc Adv Surg Tech A 2010; 20:305-9. [PMID: 20374016 DOI: 10.1089/lap.2010.9997] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pediatric inguinal hernia and hydrocele share a common etiology as well as management. The era of minimal access surgery is challenging the conventional surgical management for pediatric inguinal hernia in particular. This review article aims to highlight the nature of diagnosis and treatment for both hernia and hydrocele and examines both the traditional and contemporary treatment strategies from an evidence-based perspective.
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Affiliation(s)
- Simon Clarke
- Department of Pediatric Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK.
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31
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32
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A tailored approach for the treatment of indirect inguinal hernia in adults—an old problem revisited. Langenbecks Arch Surg 2010; 396:187-92. [DOI: 10.1007/s00423-010-0635-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 02/25/2010] [Indexed: 01/28/2023]
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Abstract
PURPOSE The purpose of this study was to review our management of neonatal inguinal hernias in premature infants over a 5-year period to ascertain any change in practice. METHODS Premature infants who underwent inguinal herniotomy between 2002 and 2006 were identified. Case notes were analyzed recording patient demographics, primary side, complications, recurrence and how many re-presented with a metachronous hernia. RESULTS 172 preterm infants were identified: 162 males (94.2%) and 10 females (5.8%). Median gestation was 31 weeks (25-36.7). Eighteen (10.4%) were incarcerated. Median age at surgery was 66.5 days (0-284). Thirty-two (18.6%) had bilateral hernias. Of the 63 who underwent unilateral herniotomy, 9 (14.3%) re-presented with a metachronous hernia. Median time to returning was 24 days. The number of contralateral explorations decreased over the study period. The complication rate was 6.4%. Median follow-up was 2.83 years (0.33-5.4). CONCLUSIONS This is one of the largest series showing the current practice in managing preterm infants with inguinal hernia. There are limitations to this study and the follow-up period is short. The value of contralateral groin exploration in premature neonates remains doubtful and we have shown that the overall practice has changed.
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Single Incision Miniature Pyeloplasty and Ipsilateral Inguinal Herniorrhaphy in Infants. J Urol 2010; 183:1545-9. [DOI: 10.1016/j.juro.2009.12.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Indexed: 11/18/2022]
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Are there any predictive factors of metachronous inguinal hernias in children with unilateral inguinal hernia? Hernia 2009; 13:613-5. [DOI: 10.1007/s10029-009-0537-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 07/08/2009] [Indexed: 11/25/2022]
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Toufique Ehsan M, Ng ATL, Chung PHY, Chan KL, Wong KKY, Tam PKH. Laparoscopic hernioplasties in children: the implication on contralateral groin exploration for unilateral inguinal hernias. Pediatr Surg Int 2009; 25:759-62. [PMID: 19652984 DOI: 10.1007/s00383-009-2429-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inguinal hernias are commonly seen in the paediatric population. Controversies still exist regarding the need for contralateral groin exploration when an unilateral inguinal hernia is presented, since the true incidence of contralateral patent processus vaginalis is not known. With the advent of laparoscopic hernioplasty, the status of the contralateral side can be evaluated at the same setting. Here, we describe our experience in this issue after the introduction of laparoscopic hernioplasty in our unit. METHODS A retrospective review was carried out between October 2002 and January 2008. All patients presented with unilateral inguinal hernias were included. The demographics of the patients and the operative findings at laparoscopy were recorded. Statistics were performed using Student t-test or chi(2) test as appropriate and p < 0.05 was taken as statistically significant. RESULTS During the study period, 363 children were included in our study, of which there were 292 males and 71 females. 212 patients presented with right-sided hernias and 151 were left-sided. The mean age of patients at presentation was 48.8 months. The incidence of contralateral PPV overall was 39.7%. There was no decrease in incidence of having a contralateral inguinal hernia in relation to age. CONCLUSION Laparoscopy can accurately diagnose contralateral PPV in children who undergo unilateral inguinal hernia repair and thus holds an advantage over open herniotomy. Furthermore, there should not be an age criteria for contralateral exploration for surgeons who perform open herniotomy.
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Affiliation(s)
- Md Toufique Ehsan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, China
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