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Stewart S, Cruz-Centeno N, Marlor DR, St Peter SD, Oyetunji TA. Bridging the Gap: Pediatric General Surgery for the Pediatrician. Pediatr Rev 2023; 44:632-643. [PMID: 37907417 DOI: 10.1542/pir.2022-005894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
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Choo CS, Chen Y, McHoney M. Delayed versus early repair of inguinal hernia in preterm infants: A systematic review and meta-analysis. J Pediatr Surg 2022; 57:527-533. [PMID: 35934526 DOI: 10.1016/j.jpedsurg.2022.07.001] [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] [Received: 10/07/2021] [Revised: 05/28/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the clinical outcomes of herniotomy in preterm infants undergoing early versus delayed repair, the risk factors for complications, and to identify best timing of surgery. METHODS Medline, Embase and Central databases were searched from inception until 25 Jan 2021 to identify publications comparing the timing of neonatal inguinal hernia repair between early intervention (before discharge from first hospitalization) and delayed (after first hospitalisation discharge) intervention. Inclusion criteria was preterm infants diagnosed with inguinal hernia during neonatal intensive care unit admission. Results were analyzed using fixed and random effects meta-analysis (RevManv5.4). RESULTS Out of 721 articles found, six studies were included in the meta-analysis. Patients in the early group had lower odds of developing incarceration [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.34-0.55, I2 = 0%, p < 0.001]; but higher risk of post-operative respiratory complications (OR 4.36, 95% CI 2.13-8.94, I2 = 40%, p < 0.001). No significant differences were reported in recurrence rate (OR 3.10, 95% CI 0.90-10.64, I2 = 0%, p = 0.07) and surgical complication rate (OR 0.94, 95% CI 0.18-4.83, I2 = 0%, p = 0.94) between early and delayed groups. CONCLUSION While early inguinal hernia repair in preterm infants reduces the risk of incarceration, it increases the risk of post-operative respiratory complications compared to delayed repair. Surgeons should discuss the risks and benefits of delaying inguinal hernia repair with the caregivers to make an informed decision best suited to the patient physiology and circumstances. LEVEL OF EVIDENCE Treatment study, level 3.
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Affiliation(s)
- Candy Sc Choo
- University of Edinburgh, Edinburgh, United Kingdom; Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Yong Chen
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Merrill McHoney
- University of Edinburgh, Edinburgh, United Kingdom; Consultant Paediatric Surgeon, Royal Hospital for Sick Children Edinburgh, Edinburgh, United Kingdom.
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Fukuhara M, Onishi S, Handa N, Sato T, Esumi G. Spontaneous reduction age for ovarian hernia in early infancy. Pediatr Int 2022; 64:e15024. [PMID: 34643013 DOI: 10.1111/ped.15024] [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: 05/26/2021] [Revised: 09/03/2021] [Accepted: 10/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many articles recommend early surgery for ovarian hernia to avoid the risk of ovarian torsion. However, while ovarian hernia is known to undergo spontaneous reduction (SR) in early infancy, few reports have described the timing of SR. We therefore investigated the clinical features of SR for ovarian hernia in early infancy. METHODS A total of 610 girls were diagnosed with inguinal hernia between 2008 and 2018. We focused on infants who had an ovarian hernia onset in the first 3 months of age. We reviewed the age retrospectively at the onset of hernia and age at SR. The data were compared statistically using the Kaplan-Meier method. RESULTS Sixty-one infants with inguinal hernia were included in this study. Thirty-nine patients (64%) had ovarian hernia. The mean age at the onset of hernia was 44 ± 17 days of age. Thirty cases underwent SR (77%). A Kaplan-Meier analysis showed that 75% of ovarian hernias underwent SR by 6 months of age. There were no cases of ovarian torsion. CONCLUSIONS Most cases of ovarian hernia underwent SR, so patients with ovarian hernia in early infancy might be treated by elective surgery after 6 months of age.
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Affiliation(s)
- Masahiro Fukuhara
- Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan
- Department of Pediatric Surgery, Kagoshima University, Kagoshima, Japan
| | - Noritoshi Handa
- Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Tomoe Sato
- Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Genshiro Esumi
- Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan
- Department of Pediatric Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Tan SS, Wang K, Xiao Y, Wang Z, Peng C, Pang W, Wu D, Chen Y. Single-Center 12-Year Analysis of Inguinal Hernia in Female Children. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Fleming MA, Grabski DF, Abebrese EL, Levin DE, Rasmussen SK, McGahren ED, Gander JW. Clinical regression of inguinal hernias in premature infants without surgical repair. Pediatr Surg Int 2021; 37:1295-1301. [PMID: 34091749 DOI: 10.1007/s00383-021-04938-7] [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: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The incidence of inguinal hernias in premature infants is approximately 30%. Due to concerns about a high risk of incarceration, early repair is commonly performed. We present a series of patients whose families opted to delay repair until after 55 weeks corrected gestational age (GA) and experienced safe clinical regression of their hernias. METHODS Between June 2015 and July 2020, premature infants (< 37 weeks GA) diagnosed with inguinal hernias on physical examination were identified. Families of eligible infants were offered either immediate or delayed repair after 55 weeks corrected GA. Infants whose families elected to delay were followed until their hernia(s) clinically regressed, or until older than 55 weeks. RESULTS Families of 68 infants consented to delay repair. 23 infants (33.8%) had hernias that clinically regressed at median follow up from diagnosis of 14.1 weeks. Univariate analysis demonstrated female sex as a significant predictor of hernia clinical regression (OR: 3.08; p = 0.046). Of the 45 infants who underwent repair, 84.4% safely progressed to 55 weeks corrected GA prior to. CONCLUSION Delaying inguinal hernia repair in this series of premature infants until after 55 weeks corrected GA revealed that one third of hernias, especially in females, safely regressed upon follow-up examination.
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Affiliation(s)
- Mark A Fleming
- Department of Surgery, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22908, USA.
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22908, USA
| | | | - Daniel E Levin
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sara K Rasmussen
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Eugene D McGahren
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jeffrey W Gander
- Department of Surgery, Division of Pediatric Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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Wang K, Tan SS, Xiao Y, Wang Z, Peng C, Pang W, Wu D, Chen Y. Characteristics and treatments for pediatric ordinary and incarcerated inguinal hernia based on gender: 12-year experiences from a single center. BMC Surg 2021; 21:67. [PMID: 33522917 PMCID: PMC7849117 DOI: 10.1186/s12893-020-01039-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Congenital primary inguinal hernia is a common condition among children. Although much literature regarding inguinal hernia is available, large scale analysis are few, and rarely do they expand on gender difference or incarcerated hernias. Methods Patients with unilateral or bilateral inguinal hernia who were admitted to our hospital and received open inguinal hernia repair (OIHR) or laparoscopic inguinal hernia repair (LIHR) under general anesthesia were included. LIHR was performed using single-site laparoscopic percutaneous extraperitoneal closure (SLPEC). Medical records were retrospectively collected and analyzed. Results A total of 12,190 patients were included in this study. The ratio of male to female was 4.8:1. There was a total of 10,646 unilateral hernias (87.3%) and 1544 bilateral hernias (12.7%), with a corresponding ratio of 6.9:1. 12,444 hernia repair surgeries, 11,083 (89.1%) OIHR and 1361 (10.9%) LIHR, were held. OIHR had a shorter operative time than LIHR for all unilateral and female bilateral repair, unlike for bilateral male repair. There was no difference between OIHR and LIHR for ipsilateral recurrent hernia in males. There was a difference between OIHR and LIHR for metachronous contralateral hernia. Incarcerated inguinal hernia was associated with longer operative time, hospital stay and higher hospital costs. Females and patients under 1 year were more likely to present with incarcerated hernia. Conclusions OIHR should be considered for male patients, especially for unilateral and complete inguinal hernia. LIHR is highly recommended for female patients. For incarcerated hernia, attention should be paid to patients under 1 year old, as they can be 60 times more susceptible, and females. Surgeons should also be aware of ovary hernias in females.
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Affiliation(s)
- Kai Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Sarah Siyin Tan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Yue Xiao
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Zengmeng Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Dongyang Wu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.
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Prenatal Diagnosis of a Cyst of the Canal of Nuck Associated With an Ovarian Cyst and Acute Polyhydramnios. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320908228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the female, the canal of Nuck is a tubular fold of parietal peritoneum that travels along with the round ligament through the inguinal canal to its attachment on the labia majora. The canal of Nuck is analogous to the processus vaginalis in the male. In embryonic development, this pathway typically obliterates early in life; however, in some cases, it may partially or completely fail to close. This failure to obliterate can lead to complications ranging from a cyst of the canal of Nuck (also known as a female hydrocele) to herniation and incarceration of abdominal and pelvic organs. There is little information available in the medical literature concerning this rare condition; therefore, it is important for sonographers, physicians, and surgeons to be familiar with this developmental abnormality. This report represents the first prenatal case of a cyst of the canal of Nuck, along with the unique combination of a large left fetal ovarian cyst and acute polyhydramnios. The embryology, incidence, differential diagnosis, management, and treatment of these female conditions are discussed.
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Masoudian P, Sullivan KJ, Mohamed H, Nasr A. Optimal timing for inguinal hernia repair in premature infants: a systematic review and meta-analysis. J Pediatr Surg 2019; 54:1539-1545. [PMID: 30541673 DOI: 10.1016/j.jpedsurg.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/10/2018] [Accepted: 11/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The optimal timing of repair for inguinal hernia in premature infants remains a controversial topic. Our objective was to assess the clinical effects of inguinal hernia repair done before or after neonatal intensive care unit (NICU) discharge. METHODS MEDLINE, Embase, CINAHL, and CENTRAL were searched in July 2018. Publications comparing clinical outcomes of the premature infants with inguinal hernia repair before (early) and after (delayed) NICU discharge were identified. Two reviewers independently screened studies, extracted data, and assessed for quality. Results were pooled using random effects meta-analysis. RESULTS Of 640 publications identified, six comparative studies assessing a total of 1761 premature infants were included. Meta-analysis indicated no statistically significant difference in incarceration rate (odds ratio (OR) 2.15, 95% confidence interval (CI) 0.83-5.58, I2 = 0%), surgical complications (OR 2.36, 95% CI 0.66-8.41, I2 = 0%) and other secondary complications. However, the odds of recurrence and respiratory difficulty was significantly increase in the early group compared to delayed (OR 4.12, 95% CI 1.17-14.45, I2 = 0%; OR 3.59, 95% CI 1.10-11.75, I2 = 42%). CONCLUSIONS Repair of inguinal hernia in premature infants before NICU discharge may increase the odds of recurrence, but not incarceration or surgical complications. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Pourya Masoudian
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5.
| | - Katrina J Sullivan
- Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1.
| | - Hisham Mohamed
- Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1.
| | - Ahmed Nasr
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5; Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1.
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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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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Outcomes following laparoscopic versus open surgery for pediatric inguinal hernia repair: Analysis using a national inpatient database in Japan. J Pediatr Surg 2019; 54:577-581. [PMID: 29661573 DOI: 10.1016/j.jpedsurg.2018.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database. METHODS Using the Diagnosis Procedure Combination database in Japan, we compared duration of anesthesia, postoperative complications, recurrence, and metachronous hernia (MH) between LS and OS for children undergoing inguinal hernia repair from July 2010 to March 2016. We used multivariable logistic regression analysis for postoperative complications and Cox regression analysis for recurrence. RESULTS For 75,486 eligible patients (LS 20,186 vs. OS 55,300), the median follow-up was 815 (381-1350) days in LS and 1106 (576-1603) days in OS. The duration of anesthesia was significantly longer in LS than in OS for unilateral surgery (80 vs. 70min, p<0.001) but shorter for bilateral surgery (86 vs. 96min, p<0.001). LS had a lower proportion of MH than OS (0.3% vs. 3.4%, p<0.001). There was no significant difference between LS and OS in complications (odds ratio: 0.55; 95% confidence interval: 0.22-1.38; p=0.20) or recurrence (hazard ratio: 1.24; 95% confidence interval: 0.86-1.79; p=0.89). CONCLUSIONS LS patients had lower proportions of MH than OS patients. Complications and recurrence did not differ significantly between LS and OS. TYPE OF STUDY Retrospective study. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo.
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Zakaria OM. Patent Contralateral Processus Vaginalis in Infants and Children: Is Herniotomy Justified? Oman Med J 2018; 33:481-485. [PMID: 30410690 DOI: 10.5001/omj.2018.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Contralateral inguinal exploration in pediatric unilateral inguinal hernia has been an issue of debate. Controversy still exists on whether contralateral patent processus vaginalis (CPPV) is justifiable for herniotomy. This study was conducted to investigate the hypothesis that CPPV always necessitates herniotomy. Methods This prospective study was conducted on 200 pediatric patients aged 2-120 months old. All patients clinically diagnosed with a unilateral inguinal hernia underwent a clinical examination of both inguinoscrotal regions followed by ultrasonography to elucidate CPPV in both sides. Herniotomy was then performed on the hernia site with laparoscopic evaluation of CPPV. Contralateral herniotomy was performed in 44 patients with Chin's type III CPPV while the rest were followed-up for three years to detect the appearance of any contralateral inguinal hernia. Results The current study included 158 boys and 42 girls (ratio of 3.8:1.0). Hernia was more common on the right side (n = 136) than the left side (n = 64). Bilateral herniotomy was performed on 44 patients with Chin's type III CPPV, while the remaining 156 patients underwent unilateral herniotomy. During the follow-up period, contralateral hernia appeared in 58 patients; the remaining 98 patients, proved to have CPPV did not complain of a clinical hernia during that period. Conclusions Inguinal herniotomy for CPPV seems not to be necessary in all cases. This would decrease the use of anesthesia and surgical morbidity in young infants and save hospital resources through avoidance of
unnecessary operations.
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Affiliation(s)
- Ossama M Zakaria
- Department of Surgery, Division of Pediatric Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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12
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Variation in the use of laparoscopy with inguinal hernia repairs in a sample of pediatric patients at children's hospitals. J Pediatr Urol 2018; 14:158.e1-158.e7. [PMID: 29195832 DOI: 10.1016/j.jpurol.2017.10.008] [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] [Received: 01/12/2017] [Accepted: 10/02/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/BACKGROUND Metachronous contralateral inguinal hernias (MCH) occur in approximately 10% of pediatric patients following unilateral inguinal hernia repairs (UIHR). Laparoscopic evaluation of the contralateral internal ring is a method of identifying high-risk individuals for prophylactic contralateral exploration and repair. OBJECTIVE The objective of this study was to assess variation in utilization of diagnostic laparoscopy, and report costs associated with the evaluation of a contralateral patent processus vaginalis during hernia repair in pediatric hospitals. STUDY DESIGN The Pediatric Health Information System database was searched to identify outpatient surgical encounters for pediatric patients with a diagnosis of inguinal hernia during a 1-year period (2014). Records were identified that contained diagnostic codes for unilateral or bilateral inguinal hernia in combination with a procedure code for open hernia repair with or without diagnostic laparoscopy. RESULTS After exclusions there were 3952 hernia repairs performed at 30 hospitals; median age was 4 years (IQR 1-7), 78.8% were male, and 64.9% Caucasian. Three-quarters (76.7%) had UIHR, 8.6% had unilateral repairs with laparoscopy (UIHRL), 12.2% had bilateral inguinal hernia repairs (BIHR), and 2.4% had bilateral repairs with laparoscopy (BIHRL). Where laparoscopy was used, 78% resulted in a unilateral repair and 22% in a bilateral procedure. The percent of patients undergoing laparoscopy varied from 0 to 57% among hospitals, and 0-100% among surgeons. Pediatric surgeons were more than three times more likely to perform a diagnostic laparoscopy compared with pediatric urologists. Median adjusted costs were $2298 (IQR 1659-2955) for UIHR, $2713 (IQR 1873-3409) for UIHRL, $2752 (IQR 2230-3411) for BIHR, and $2783 (IQR 2233-3453) for BIHRL. Median costs varied over two-fold among hospitals ($1310-4434), and over four-fold among surgeons ($948-5040). DISCUSSION Data suggested that <10% of patients with clinically unilateral inguinal hernias developed MCH. A negative diagnostic laparoscopy ensured that 0.9-1.31% developed MCH. However, up to 30% of patients underwent contralateral exploration/repair when diagnostic laparoscopy was used. The current study found increased costs associated with the use of laparoscopy, with considerable variation in costs among surgeons and hospitals. These data elucidate competing financial and clinical consequences associated with the use of diagnostic laparoscopy with clinically unilateral hernias. CONCLUSIONS Variation existed in the use of laparoscopy during inguinal hernia repairs and associated costs within the current sample from children's hospitals in the United States. The additional costs of laparoscopic evaluation must be considered against the clinical utility and therapeutic consequences of identifying individuals with a higher risk of metachronous contralateral inguinal hernia.
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13
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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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Chen J, Chu C, Shen Y, Zou Z, Yuan X. Individualized Treatment of Inguinal Hernia in Children. Hernia 2017. [DOI: 10.5772/intechopen.68875] [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]
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Weaver KL, Poola AS, Gould JL, Sharp SW, St Peter SD, Holcomb GW. The risk of developing a symptomatic inguinal hernia in children with an asymptomatic patent processus vaginalis. J Pediatr Surg 2017; 52:60-64. [PMID: 27842956 DOI: 10.1016/j.jpedsurg.2016.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with a symptomatic indirect inguinal hernia have a patent processus vaginalis (PPV). However, the reverse is unknown, as the natural history of PPV is unclear. Currently, there are little data regarding the incidence and time frame for developing a symptomatic hernia with a known asymptomatic PPV. METHODS A retrospective chart review was conducted in children who were evaluated for a PPV during nonhernia laparoscopic surgery by a single pediatric surgeon (GWH) from 2000 to 2014. Those patients with intraoperative findings of PPV were followed up by chart review and phone inquiry. RESULTS 1548 children underwent a laparoscopic operation, with 308 having an asymptomatic PPV. Phone contact was successful in 125 (43%) of these patients at a median of 8.1years (range 4.8-12.7) after the initial laparoscopic operation. Nineteen (13%) patients returned with a symptomatic hernia at a median age of 17months (range: 5-74) and a median presentation of 9months (range: 1-66) after the initial laparoscopy. Ten hernia repairs were unilateral and 9 bilateral. None of those who were contacted via phone inquiry reported hernia symptoms or hernia repair. CONCLUSIONS These data suggest that the risk of developing a symptomatic hernia during childhood in the presence of a known PPV is relatively low. LEVEL OF EVIDENCE Level 3; type of study: retrospective study.
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Affiliation(s)
- Katrina L Weaver
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Ashwini S Poola
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Joanna L Gould
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Susan W Sharp
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - George W Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
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Kurobe M, Baba Y, Otsuka M. Inguinal hernia in very low-birthweight infants: Follow up to adolescence. Pediatr Int 2016; 58:1322-1327. [PMID: 27285670 DOI: 10.1111/ped.13060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/04/2016] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study reviewed the medical records of very low-birthweight infants (VLBWI) followed up to adolescence, with emphasis on inguinal hernia (IH), to discuss the ideal time for IH repair in VLBWI. METHODS Medical records from 274 VLBWI treated in the neonatal intensive care unit (NICU) between 1994 and 1999 were collected retrospectively. Outpatient data after NICU discharge were included. Additionally, a follow-up study was undertaken via questionnaire sent to the families of VLBWI in 2011. RESULTS During NICU hospitalization, IH was diagnosed in 39 of 274 VLBWI, and two developed incarceration. Thirty-eight VLBWI were discharged with known hernia, and elective repair was performed in 19. Three developed incarceration before elective repair at the mean age of 316 days. In the remaining 18 cases of IH, spontaneous regression occurred at a mean age of 180 days and repair was not performed. New IH appeared in 25 VLBWI after NICU discharge. CONCLUSIONS The high incidence of IH in VLBWI was confirmed during follow up to adolescence. The rate of incarceration was low and the incidence of spontaneous regression was high. Observation up to 6 months without surgery, with the expectation of spontaneous regression, is one option to avoid unnecessary surgery, but repair should be performed before 10 months to reduce the risk of incarceration. Further large, prospective, and randomized controlled studies with a long follow up are necessary to validate the present results and to define the ideal time for IH repair in VLBWI.
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Affiliation(s)
- Masashi Kurobe
- Department of Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Yuji Baba
- Department of Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Masahiko Otsuka
- Department of Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
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Centeno-Wolf N, Mircea L, Sanchez O, Genin B, Lironi A, Chardot C, Birraux J, Wildhaber BE. Long-term outcome of children with patent processus vaginalis incidentally diagnosed by laparoscopy. J Pediatr Surg 2015; 50:1898-902. [PMID: 26233492 DOI: 10.1016/j.jpedsurg.2015.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/10/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patent processus vaginalis (PPV) might be incidentally diagnosed during laparoscopy. The aims of this study were to determine the prevalence and the natural history of PPV, i.e. its possible development into symptomatic inguinal hernia. INCLUSION CRITERIA children <16years undergoing laparoscopy for pathologies other than processus vaginalis (PV) related, from 10/2000-10/2005. EXCLUSION CRITERIA past or present history of PV-related pathologies. The internal inguinal rings were documented during laparoscopy. Follow-up was provided by phone inquiry and clinical examination if needed. Median follow-up was 10.5years (range 7.1-12.8). RESULTS 416 patients were included. Median age at laparoscopy was 12.4years (range 3days-18.1years). Forty-three PPV (33 unilateral, 5 bilateral) were found in 38 patients (9.1%). Four children with PPV presented later with an ipsilateral inguinal hernia (10.5%, 95%CI [3%; 25%]), at a median age of 16.0years (range 11.8-17.3), at a median of 22.5months (range 12-50) after initial laparoscopy, as compared to no patient in the population with obliterated PV (0%, 95%CI [0%; 1%]). CONCLUSION 9.1% of the observed pediatric population showed an asymptomatic PPV, and 10.5% of these children later developed an inguinal hernia. None of the children with obliterated PV developed a hernia.
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Affiliation(s)
- N Centeno-Wolf
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - L Mircea
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - O Sanchez
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - B Genin
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - A Lironi
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - C Chardot
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - J Birraux
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - B E Wildhaber
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland.
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Very Low Birth Weight Is an Independent Risk Factor for Emergency Surgery in Premature Infants with Inguinal Hernia. J Am Coll Surg 2015; 220:347-52. [DOI: 10.1016/j.jamcollsurg.2014.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/28/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
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Laparoscopic inguinal hernia repair in children using the percutaneous internal ring suturing technique - own experience. Wideochir Inne Tech Maloinwazyjne 2014; 9:53-8. [PMID: 24729810 PMCID: PMC3983550 DOI: 10.5114/wiitm.2014.40389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/12/2013] [Accepted: 08/05/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Percutaneous internal ring suturing (PIRS) is a method of laparoscopic herniorrhaphy, i.e. percutaneous closure of the internal inguinal ring under the control of a telescope placed in the umbilicus. AIM To evaluate the usefulness of the PIRS technique. MATERIAL AND METHODS Fifty-five children (39 girls and 16 boys) underwent surgery using this method in our institution between 2008 and 2010. RESULTS In 10 cases the presence of an open inguinal canal on the opposite side was also noted during surgery, and umbilical hernia was recognized in 2 patients. In 5 cases it was necessary to convert to the open surgery because of the inability to continue the laparoscopic procedure. In 1 case, male pseudohermaphroditism was diagnosed during surgery. Recurrent inguinal hernia required a conventional method of surgery in 1 child. Other children did not exhibit the characteristics of hernia recurrence. The inguinal canals were followed up with postoperative ultrasound examination in 29 children. In 23 children, the ultrasound examination showed no dilatation of the inguinal canal. In the other 6 children dilatation of the inguinal canal or the presence of fluid within the inguinal canal was observed during ultrasound. In 6 children symptoms such as swelling and soreness around the inguinal canal developed within 3 to 6 months after surgery. CONCLUSIONS Inguinal hernia surgery using the PIRS procedure is an alternative, effective, minimally invasive method of surgery. Visualization of the peritoneal cavity allows for detection of other abnormalities, as well as for performing other procedures during the same session (such as closing the contralateral inguinal canal or umbilical hernia surgery).
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Takahashi A, Toki F, Yamamoto H, Otake S, Oki Y, Kuwano H. Outcomes of herniotomy in premature infants: recent 10 year experience. Pediatr Int 2012; 54:491-5. [PMID: 22414268 DOI: 10.1111/j.1442-200x.2012.03607.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The timing of herniotomy in premature infants is controversial. METHODS Outcomes of herniotomy in 47 premature infants admitted to the neonatal intensive care unit (NICU) were retrospectively reviewed for preoperative clinical features, respiratory interventions, and anesthetic and surgical complications. The data were compared with those of full-term infants (n = 52). Fourteen of the premature infants underwent herniotomy before NICU discharge and 33 after discharge. The predictive factors for anesthetic and surgical complications were also investigated via multiple regression analysis. RESULTS Mean post-conceptional age at surgery in premature infants and full-term infants was 47 weeks and 50 weeks, respectively. Mean bodyweight at surgery in those infants was 4087 g and 5454 g, respectively. The rate of incarcerated hernia and emergency surgery was lower in premature infants. Delayed extubation of the tracheal tube after surgery was noted in four premature infants, but not in full-term infants. Two cases of cryptorchidism in premature infants and one recurrence in a full-term infant that required reoperation were noted. On multiple regression analysis no factor (including respiratory interventions) was found to be capable of predicting complications. CONCLUSION Although no predictive factor for complications was identified, there were some anesthetic and surgical complications in premature infants. If there is no risk of incarceration, herniotomy in premature infants should be performed at a time when the risk of anesthetic complications is decreased. If there is a risk of incarcerated hernia, herniotomy should be performed carefully in order to avoid occurrence of anesthetic and surgical complications.
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Affiliation(s)
- Atsushi Takahashi
- Division of Pediatric Surgery, Department of General Surgical Science Neonatal Intensive Care Unit, Gunma University Hospital, Maebashi, Japan.
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Lao OB, Fitzgibbons RJ, Cusick RA. Pediatric inguinal hernias, hydroceles, and undescended testicles. Surg Clin North Am 2012; 92:487-504, vii. [PMID: 22595705 DOI: 10.1016/j.suc.2012.03.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric inguinal hernias are extremely common, and can usually be diagnosed by simple history taking and physical examination. Repair is elective, unless there is incarceration or strangulation. Hydroceles are also quite common, and in infancy many will resolve without operative intervention. Undescended testicles harbor an increased risk of infertility and malignancy, and require orchiopexy in early childhood.
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Affiliation(s)
- Oliver B Lao
- Department of Pediatric Surgery, Children's Hospital and Regional Medical Center, University of Nebraska College of Medicine, 8200 Dodge, Omaha, NE 68114, USA
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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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25
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Mollen KP, Kane TD. Inguinal hernia: what we have learned from laparoscopic evaluation of the contralateral side. Curr Opin Pediatr 2007; 19:344-8. [PMID: 17505198 DOI: 10.1097/mop.0b013e3281574597] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The evaluation for and management of a contralateral patent processus vaginalis in children presenting with a unilateral inguinal hernia has been debated for over 60 years. The emergence of transinguinal laparoscopy as an evaluative tool has changed the landscape of the debate, offering a safe and minimally invasive option. The review will highlight some of the significant recent contributions to this debate. RECENT FINDINGS Recent studies have confirmed the safety of transinguinal laparoscopy, and demonstrated a high level of sensitivity and specificity for it in the evaluation of the contralateral inguinal ring. In comparison, the practice of physical examination under anesthesia for evaluation of the contralateral inguinal region has proven to be ineffective. Further, age and gender differences in the incidence of contralateral patent processus vaginalis have recently been challenged. These data call into question the practices of routine or selective open inguinal exploration and present laparoscopy as the most effective means of evaluation. SUMMARY Transinguinal laparoscopy offers a safe and effective means of evaluating the contralateral inguinal ring during ipsilateral hernia repair. The relatively high incidences of both contralateral patent processus vaginalis and contralateral metachronous hernia development in children justify the use of routine laparoscopic evaluation.
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Affiliation(s)
- Kevin P Mollen
- Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
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Marulaiah M, Atkinson J, Kukkady A, Brown S, Samarakkody U. Is contralateral exploration necessary in preterm infants with unilateral inguinal hernia? J Pediatr Surg 2006; 41:2004-7. [PMID: 17161192 DOI: 10.1016/j.jpedsurg.2006.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/1899] [Revised: 12/30/1899] [Accepted: 12/30/1899] [Indexed: 11/20/2022]
Abstract
PURPOSE Contralateral inguinal exploration has been the preferred approach to preterm infants with unilateral inguinal hernia. There is no literature evidence to justify this. The aim of this prospective study is to analyze the incidence and to determine any risk factors for the development of contralateral metachronous hernia (MH) in the preterm when compared with term infants. METHODS Preterm and term infants with unilateral inguinal hernia younger than 6 months who underwent surgery were included. Those infants who subsequently developed MH were analyzed. RESULTS Two hundred sixty-six patients met the inclusion criteria. One hundred five were preterm and 161 were term. Ten preterm (10.31%) and 9 term infants (5.92%) presented subsequently with MH (P =.18). All but 1 were male. There was no relation between the side of hernia, presentation with incarceration, age at surgery, sex of the patient, and the development of MH. However, a trend toward a higher incidence of MH in very low birth weight and early gestational age preterms was noted. CONCLUSION There is no significant difference between the occurrence of MH in preterm when compared with term infants. Routine contralateral exploration in preterm infants with its associated risks is therefore not justified in unilateral hernia.
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Affiliation(s)
- Mohan Marulaiah
- Department of Pediatric Surgery, Waikato Hospital, Hamilton, New Zealand
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