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Ramsey WA, Huerta CT, O'Neil CF, Taylor RR, Saberi RA, Gilna GP, Collie BL, Lyons NB, Parreco JP, Thorson CM, Sola JE, Perez EA. Timing of Pediatric Incarcerated Inguinal Hernia Repair: A Review of Nationwide Readmissions Data. J Surg Res 2024; 295:641-646. [PMID: 38103321 DOI: 10.1016/j.jss.2023.11.059] [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: 03/01/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION In pediatric patients, incarcerated inguinal hernias are often repaired on presentation. We hypothesize that in appropriate patients, repair may be safely deferred. METHODS The Nationwide Readmissions Database was used to identify pediatric patients (aged < 18 y) with incarcerated inguinal hernia from 2010 to 2014. Patients were stratified by management approach (Early Repair versus Deferral). Overall frequencies of these operative strategies were calculated. Propensity score matching was then performed to control for patient age, comorbidities, perinatal conditions, and congenital anomalies. Outcomes including complications, surgical procedures, and readmissions were compared. Outpatient surgeries were not assessed. RESULTS Among 6148 total patients with incarcerated inguinal hernia, the most common strategy was to perform Early Repair (88% versus 12% Deferral). Following propensity score matching, the cohort included 1288 patients (86% male, average age 1.7 ± 4.1 years). Deferral was associated with equivalent rates of readmission within one year (13% versus 15%, P = 0.143), but higher readmissions within the first 30 days (7% versus 3%, P = 0.002) than Early Repair. Deferral patients had lower rates of orchiectomy (2% versus 5%, P = 0.001), wound infections (< 2% versus 2%, P = 0.020), and other infections (7% versus 15%, P < 0.001). The frequency of other complications including bowel resection, oophorectomy, testicular atrophy, sepsis, and pneumonia were equivalent between groups. Three percent of Deferrals had a diagnosis of incarceration on readmission. CONCLUSIONS Deferral of incarcerated inguinal hernia repair at index admission is associated with higher rates of hospital readmissions within the first 30 days but equivalent readmission within the entire calendar year. These patients are at risk of repeat incarceration but have significantly lower rates of orchiectomy than their counterparts who undergo inguinal hernia repair at the index admission. We propose that prospective studies be performed to identify good candidates for Elective Deferral following manual reduction and overnight observation. Such studies must capture outpatient surgical outcomes.
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Affiliation(s)
- Walter A Ramsey
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| | - Carlos T Huerta
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher F O'Neil
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ruby R Taylor
- University of Miami Miller School of Medicine, Miami, Florida
| | - Rebecca A Saberi
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Gareth P Gilna
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Brianna L Collie
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicole B Lyons
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Joshua P Parreco
- Division of Trauma and Surgical Critical Care, Memorial Regional Hospital, Hollywood, Florida
| | - Chad M Thorson
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Hoang VT, Van HAT, Hoang TH, Nguyen TTT, Trinh CT. A Review of Classification, Diagnosis, and Management of Hydrocele. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:599-607. [PMID: 38010662 DOI: 10.1002/jum.16380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
This article summarizes and updates a number of issues related to hydrocele including anatomy, embryology, classification, etiology, clinical manifestations, imaging findings, and management. Hydrocele is an abnormal collection of serous fluid between the parietal and visceral layers arising from the mesothelial lining of the tunica vaginalis that surrounds the testis and spermatic cord directly. Hydroceles result from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis. Hydroceles can be divided into two types as primary and secondary. The diagnosis should be based on medical history, clinical manifestations, and imaging studies. Understanding the causes and types of hydroceles is useful for accurately diagnosing and treatment strategy. Hydroceles can be managed by conservative treatment, fluid aspiration, or hydrocelectomy.
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Affiliation(s)
- Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Hoang Anh Thi Van
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - The Huan Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | | | - Cong Thao Trinh
- Department of Radiology, FV Hospital, Ho Chi Minh City, Vietnam
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Jaweesh S, Jaweesh M, Mahgaa MT, Ali S, Alfandi A, Mahmoud MZ. Diagnosis and management of a rare case of encysted hydrocele of spermatic cord: Case report and literature review. Int J Surg Case Rep 2024; 115:109299. [PMID: 38277986 PMCID: PMC10839639 DOI: 10.1016/j.ijscr.2024.109299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE A hydrocele is typically a non-cancerous condition that arises from the accumulation of fluid between the layers of the vaginal process. Diagnosis primarily involves a physical examination. In instances where the condition is mistaken for other pathological conditions, additional investigations may be undertaken. Surgical intervention is typically deferred until after the age of one year, unless the hydrocele is significantly large. CASE PRESENTATION A case was presented of a 4-year-old boy who was referred to the hospital with a suspected deep inguinal hernia. Upon examination, it was determined that the mass was actually an encysted hydrocele of spermatic cord. The patient underwent a minimally invasive surgery to remove the spermatocele, and the procedure was successful. CLINICAL DISCUSSION This emphasizes the importance of obtaining a detailed patient history and conducting a comprehensive physical examination, which often provide sufficient information to make a diagnosis. In many instances, these initial steps can spare patients from undergoing additional tests that may be invasive or pose unnecessary risks. CONCLUSION It is important to note that in cases of hydroceles, conservative treatment, such as observation, is the primary approach before the age of one year. Surgery is typically reserved for older children or those with large hydroceles.
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Affiliation(s)
- Shkri Jaweesh
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria.
| | | | | | - Sanaa Ali
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
| | - Abdullah Alfandi
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
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Lim AM, Yap TL, Kong JY. Incarcerated hernia with ileal perforation in an extreme preterm infant. BMJ Case Rep 2023; 16:e257640. [PMID: 37914168 PMCID: PMC10626876 DOI: 10.1136/bcr-2023-257640] [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] [Indexed: 11/03/2023] Open
Abstract
We describe a case of a premature 24 weeks gestation infant who presented with clinical lability and abdominal distention with initial concerns of necrotising enterocolitis. On further examination, a right inguinal hernia was noted and serial abdominal X-rays showed bowel loop dilatation with intramural air and no perforation. However, the hernia was recurrent and later found to be not reducible. He underwent right groin exploration. Intraoperatively, distal ileal perforation was noted and he was found to have an additional five sites of perforation. He had a stoma sited at the left iliac fossa as well as primary anastomosis at the site of the second to fifth perforations. He had a stormy postoperative period but is currently doing well. Although obstructed hernias are rare in the initial course of an extreme preterm infant, it should not be missed as a cause of intestinal obstruction and early surgical opinion should be sought.
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Affiliation(s)
- Alicia May Lim
- Neonatology, KK Women's and Children's Hospital, Singapore
| | - Te-Lu Yap
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Juin Yee Kong
- Neonatology, KK Women's and Children's Hospital, Singapore
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Kim JY, Chung JM, Don Lee S. Metachronous Contralateral Occurrence of Hydrocele After Unilateral Hydrocelectomy in Children Younger Than 8 Years. J Korean Med Sci 2023; 38:e79. [PMID: 36918032 PMCID: PMC10010910 DOI: 10.3346/jkms.2023.38.e79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/19/2022] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hydrocele on the contralateral side after surgical repair is an uncommon condition compared to surgical site recurrence. Although there has been much research on metachronous contralateral inguinal hernia in children, metachronous contralateral hydrocele, which share a common pathology with inguinal hernias, has not yet been investigated. We have investigated the incidence and risk factors for metachronous contralateral occurrence of communicating and noncommunicating hydroceles in children younger than 8 years. METHODS From January 2017 to June 2020, 302 children younger than 8 who were diagnosed with unilateral hydroceles were treated in our hospital without surgical exploration of contralateral hydrocele. The disease was classified into communicating and noncommunicating hydroceles. We divided patients into two groups according to the presence of metachronous contralateral hydrocele and analyzed the differences between the two groups. RESULTS Among 302 patients, the mean age was 36.4 ± 20.9 months. Metachronous contralateral hydrocele occurred in 15 (4.9%) patients as communicating hydroceles. Comparison between the two groups showed statistically significant differences in type of hydrocele (P = 0.047) at first diagnosis. CONCLUSION Clinically evident risk of metachronous contralateral hydrocele after unilateral hydrocelectomy was 4.9%. Despite the relatively low incidence rate, the risk of metachronous contralateral occurrence should always be consulted with parents before surgical treatment of hydroceles.
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Affiliation(s)
- Jae Yeon Kim
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
| | - Jae Min Chung
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Sabra TA, Abdelgawaad MS, Abdelmohsen SM, Badawy A. Watchful waiting for communicating hydrocoele in infants. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
One of the commonest pediatric surgeries is hydrocele. There are suggestions to wait for spontaneous resolution than to operate these cases without harmful adverse events. Herein, we evaluated the outcome of the watchfulness of these cases over 18 months.
Methods
The study included 93 infants with communicating hydrocele for the Pediatric Surgery Department, Faculty of Medicine (Assiut, Egypt). They were planned to be followed up for 18 months, and indications for intervention included hernia, increasing in size, being tense, and completion of 18 months of follow-up without improvement.
Results
The gestational age of the included patients was 38.5 ± 2.2 weeks and the age at the time of presentation was 50 (7, 495) days. Most cases were bilateral, reducible, and had an intermittent course. After 18 months of follow-up, 60.2% of the patients resolved spontaneously and 39.8% were surgically treated. Age at the time of presentation was higher among operated patients. Patients with reducibility criteria on clinical examination and lack of intermittent course had higher frequency among operated patients (89.2%).
Conclusions
It is safe to wait and not to operate on infants with hydrocele up to 18 months as long as there was no hernia. Higher age at presentation and reducibility on examination are indicators that favor the need for surgery.
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Risteski T, Memeti S. Benefits of Contralateral Patent Processus Vaginalis Closure During Laparoscopic Surgery for Inguinal Hernia in Female Children. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:69-75. [PMID: 35843918 DOI: 10.2478/prilozi-2022-0020] [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] [Indexed: 06/15/2023]
Abstract
After more than a decade, an accurate description of the current state of pediatric inguinal hernia repair still an issue of contention. Improvement of techniques together with patient-entered intervention that account for the experiences related to individual disease characteristics have become an important factor of which the surgeon must be aware. Therefore, the aim of this study is to analyze a potential treatment for metachronous contralateral inguinal hernia (MCIH) in children during laparoscopic assisted percutaneous internal inguinal ring suturing (PIRS). In a prospective clinical study, carried out at the University Clinic for Pediatric Surgery in Skopje, Republic of North Macedonia, we analyzed the data from 49 female children, aged 1-14 years old, with clinically diagnosed congenital inguinal hernia treated via PIRS. The position of hernias on the right side was 29 (59.2%) on the left side was 19 (38.8%) and on both sides was 1 (2.0%). With intraoperative assessment, it was determined that in 33 (67.3%) participants there was no presence of a hidden hernia, while in 16 (32.7%), there was indeed the presence of a hidden hernia. Of the hidden hernias determined laparoscopically [16 (100%)], 8 (50%) were left and right hidden hernias, all treated laparoscopically. The PIRS technique is a procedure where the basic advanced treatment is exploration. This also included the adequate treatment of other pathologies, such as the prophylactic closure of a contralateral patent processus vaginalis with simultaneous treatment as there is the potential for hernia in future, therefore reducing the number of metachronous inguinal hernias.
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Affiliation(s)
- Toni Risteski
- University Clinic for Pediatric Surgery, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, RN Macedonia
| | - Shaban Memeti
- University Clinic for Pediatric Surgery, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, RN Macedonia
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BAWAZIR OA, ALSAEGH MO. Orchidopexy during inguinoscrotal hydrocele repair: is it necessary? Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05259-1] [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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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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Hey MT, Mayhew MM, Rico S, Calisto J, Alkhoury F. Initial Experience with Robotic Inguinal Hernia Repair in the Adolescent Population. J Laparoendosc Adv Surg Tech A 2021; 31:1346-1350. [PMID: 34252321 DOI: 10.1089/lap.2021.0301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: There is no one standard procedure encompassing the needs and differences of the entire pediatric population for inguinal hernia repair (IHR). Several techniques can be used, including open repair, laparoscopic, and robotic-assisted laparoscopic repair. This is a report of a single pediatric hospital's experience performing robotic-assisted IHRs in an adolescent population. Methods: Robotic IHRs performed by the pediatric surgery department were prospectively captured and reviewed. The operation performed was a modified robotic transabdominal preperitoneal approach with ProGrip mesh. Results: Between January 2016 and August 2020, 11 robotic-assisted IHRs occurred. All patients were male, median weight interquartile range (IQR) was 76.6 kg (67.425-90.4 kg) and median age (IQR) was 17 years (17-18.5). All together median (IQR) total operative time was 111 (97.5-126) minutes, median (IQR) total console time was 60 (55.5-75.5) minutes. There were no complications or conversions, with all patients discharged on the day of the operation. Conclusion: This study demonstrates a safe and reliable approach to repairing inguinal hernias using robotics through a small initial case series. Robotic-assisted IHR should be considered a viable technique to optimize the surgical care of adolescents.
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Affiliation(s)
- Matthew T Hey
- Department of Surgery, Hebert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Mackenzie M Mayhew
- Department of Surgery, Hebert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Stephanie Rico
- Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Juan Calisto
- Department of Surgery, Hebert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Fuad Alkhoury
- Department of Surgery, Hebert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
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Ghosh S, Mitrabhanu K, Nath S, Sharan R, Prasad M. Large Pantaloon Hernia in a Five-months-old Infant. Indian J Pediatr 2020; 87:1085. [PMID: 32418185 DOI: 10.1007/s12098-020-03340-w] [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] [Received: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Soumyodhriti Ghosh
- Pediatric Surgery Unit, Abhishek Child And Maternity Centre, Jamshedpur, India
| | - Kumar Mitrabhanu
- Department of Pediatrics, Tata Motors Hospital, Telco, Jamshedpur, 831003, India.
| | - Smriti Nath
- Department of Pediatrics, Tata Motors Hospital, Telco, Jamshedpur, 831003, India
| | - Rajiv Sharan
- Department of Pediatrics, Tata Motors Hospital, Telco, Jamshedpur, 831003, India
| | - Mananjay Prasad
- Pediatric Surgery Unit, Abhishek Child And Maternity Centre, Jamshedpur, India
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Kurobe M, Harada A, Sugihara T, Baba Y, Hiramatsu T, Ohashi S, Otsuka M. The outcomes of conservative management and the natural history of asymptomatic hydroceles in children. Pediatr Surg Int 2020; 36:1189-1195. [PMID: 32700002 DOI: 10.1007/s00383-020-04720-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To elucidate the natural history of asymptomatic hydroceles (AHs) in children with conservative management and to discuss management strategies for AHs in children. METHODS We retrospectively reviewed 113 children with AHs who were followed without immediate surgery. Patients were divided into four groups according to age at presentation; group 1: ≤ 1 month, group 2: 1-12 months, group 3: 12-24 months, and group 4: > 24 months. Ages at spontaneous resolution or surgery were reviewed. To assess the effect of AH on the testis, testicular size before and after conservative management was compared in 11 cases. RESULTS In groups 1, 2, 3, and 4, spontaneous resolution occurred in 94.3%, 75.0%, 65.0%, and 33.3%, and the average time to resolution from presentation was 5, 5, 17, and 9 months, respectively. 41 patients underwent surgery at a mean age of 4.2 years. The testicular size did not differ significantly between before and after conservative management (14.4 vs. 14.5 mm, p = 0.483). CONCLUSION About one-third of children over 2 years of age achieve spontaneous resolution. Hydroceles with conservative management may not affect the testicular size. Thus, initial conservative management before surgery is recommend for AHs in children, even over 2 years of age.
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Affiliation(s)
- Masashi Kurobe
- Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, 180 Nishi-araijuku, Kawaguchi, Saitama, 333-0833, Japan.
| | - Atsushi Harada
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuro Sugihara
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Baba
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomomasa Hiramatsu
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinsuke Ohashi
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiko Otsuka
- Department of Surgery, Kawaguchi Municipal Medical Center, Saitama, Japan
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Bawazir OA. Delaying surgery for inguinal hernia in neonates: Is it worthwhile? J Taibah Univ Med Sci 2019; 14:332-336. [PMID: 31488964 PMCID: PMC6717073 DOI: 10.1016/j.jtumed.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 12/03/2022] Open
Abstract
Objective The incidence of inguinal hernia is high in premature infants; however, surgical repair is a high-risk procedure for these patients. The timing of hernia repair is still controversial. This study aimed to determine the optimal timing for inguinal herniotomy in neonates in a general hospital. Methods A prospective cohort study was conducted from March 2014 to September 2018. A total of 127 neonates and preterm infants were admitted to the paediatric surgery clinic with uncomplicated inguinal hernia. Herniotomy was performed in all neonates, and the patients were followed up for up to 8 months after surgery for perioperative and postoperative complications. The timing of surgery was based on the surgeon's decision along with the consent of the family to the surgical intervention. Results Of 118 neonates, as many as 53 (45%) underwent early repair and 65 (55%) underwent late repair of inguinal hernia. The demographic data were similar between the 2 groups with no significant difference. There were no significant differences in the incidence of inguinal hernia incarceration and hydrocele formation (p = 0.11 and p = 0.8, respectively); however, there was a higher incidence of inguinal hernia recurrence (p = 0.05) and postoperative apnoea (p = 0.02) in the early repair group. Conclusion Surgical repair of inguinal hernia is feasible with low morbidity in preterm babies. The risk of hernia incarceration and testicular atrophy did not increase with delayed elective hernia repair in neonates. Delayed hernia repair decreased the risk of perioperative and postoperative complications. This study recommends delaying elective hernia repair in neonates and preterm babies.
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Affiliation(s)
- Osama A Bawazir
- Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, KSA
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Amini R, Baker N, Woolridge DP, Echeverria AB, Amini A, Adhikari S. Emergency department diagnosis of an ovarian inguinal hernia in an 11-year-old female using point-of-care ultrasound. World J Emerg Med 2018; 9:291-293. [PMID: 30181799 DOI: 10.5847/wjem.j.1920-8642.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
| | - Nicola Baker
- Department of Emergency Medicine, Northwest Medical Center, Tucson, AZ, USA
| | - Dale P Woolridge
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
| | | | | | - Srikar Adhikari
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
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Shehata S, Shehata S, Wella HL, Abouheba M, Elrouby A. Pediatric inguinal hernias, are they all the same? A proposed pediatric hernia classification and tailored treatment. Hernia 2018; 22:941-946. [PMID: 30155570 DOI: 10.1007/s10029-018-1816-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To propose a new clinical classification for pediatric inguinal hernias modified from a similar classification system for adult inguinal hernia and to propose a tailored repair for each type. The impact of this approach on hernia recurrence will be assessed. METHODS This prospective and retrospective cross-sectional study was conducted in two tertiary teaching university hospitals in Egypt (Alexandria and Tanta University Children's Hospitals) from January 2013 to December 2014 on children below 12 years of age with indirect inguinal hernias who were divided into two groups: (a) prospective group I, classified according to our proposed pediatric hernia classification and tailored treatment (PHCTT) into types: pediatric Nyhus 1 (PNI) assigned for herniotomy alone, pediatric Nyhus II (PNII) assigned for herniotomy plus deep ring narrowing, and type pediatric Nyhus III (PNIII) assigned for herniotomy plus posterior wall repair. (b) Retrospective unclassified group II where all cases were assigned to herniotomy alone (open). Data about patient characteristics, assigned hernia type, operative findings, procedures done, and postoperative complications were documented and analyzed by comparing the outcomes of the two groups. RESULTS A total of 371 patients were included in this study with 401 hernias (30 bilateral); group I included of 217 patients, while group II included 154 patients. There was a male preponderance in group I (173/217 = 80%) and in group II (130/154 = 85%); the majority in both groups were less than 12 months of age, in group I (132/217 = 66%) and in group II (120/154 = 85%). The median age was 4 months and the median duration of symptoms was 2 months. For group I, PNII hernias formed the predominant cluster making 40% (94/235) followed by PNI hernias making 34.8% (82/235), while PNIII hernias were the least group being 25% (59/235) only. The mean follow-up period was 9.2 months ± 4.8 SD (and 9.1 months ± 2 SD in group II). The pooled recurrence rate was 1.9% (8/401) of the whole series, a weighted mean of the individual recurrence rates of 0% (0/235) of group I and 4.8% (8/166) of group II patients, all males. This difference in the recurrence rates between the two groups was statistically significant (P = 0.004). CONCLUSIONS Pediatric inguinal hernias are not the same and there is extreme variation in the presentation regarding the size of the defect. We proposed a nouvelle pediatric hernia classification modified from the original Nyhus classification for adult inguinal hernia with tailored surgical approach to each type (PHCTT). Applying this (PHCTT), it has the benefit of a significant reduction of recurrence rate.
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Jin Z, Wang F. Effectiveness of Laparoscopy in the Treatment of Pediatric Hydrocele: A Systematic Review. J Laparoendosc Adv Surg Tech A 2018; 28:1531-1539. [PMID: 30063415 DOI: 10.1089/lap.2018.0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To conduct a systematic review of the published studies concerning laparoscopic pediatric hydrocele (PH) repair and summarize the surgical details and operative outcomes of this procedure. Materials and Methods: A PubMed search was performed for all studies concerning laparoscopic repair of hydrocele in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND hydrocele* AND (child* OR pediatric*). Inclusion criteria included (1) children with hydrocele as the study participant; (2) laparoscopic PH repair as the main surgical procedure; and (3) operation time and complications as the outcomes of interest. Reviews, studies with insufficient information or reporting the outcomes of abdominoscrotal hydrocele, and duplicate patient series were excluded. Results: Overall, 20 studies fulfilled the inclusion criteria of this review and 15 studies were included in the final analysis. These studies comprised at least 2920 patients undergoing laparoscopic repair for various PH subtypes, of which most were conducted in Asia. Most authors repaired PH laparoscopically through an extraperitoneal approach, while only a few studies applied a laparoscopic intraperitoneal method. The majority of the studies used nonabsorbable sutures to ligate hydrocele sac, while very few studies used absorbable materials. Hydrocele sac was resected or transected in only five studies, but left alone in the majority. Mean operation time was between 15.6 and 43.2 minutes for unilateral laparoscopic PH repair and between 16.9 and 53.2 minutes for bilateral surgery. Operative complications were not very common, with a highest recurrence/persistence incidence of 1.4%. Subgroup analysis showed that hydrocele subtype, surgical approach, suture material, and management of hydrocele sac did not significantly influence the operative complications. Conclusions: laparoscopic PH repair seems to be a safe and effective procedure. Given the limitations of this review, our conclusion needs to be confirmed by more well-designed studies.
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Affiliation(s)
- Zhichang Jin
- 1 Department of Urology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Furan Wang
- 2 Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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Gulack BC, Greenberg R, Clark RH, Miranda ML, Blakely ML, Rice HE, Adibe OO, Tracy ET, Smith PB. A multi-institution analysis of predictors of timing of inguinal hernia repair among premature infants. J Pediatr Surg 2018; 53:784-788. [PMID: 29055488 PMCID: PMC7538232 DOI: 10.1016/j.jpedsurg.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/17/2017] [Accepted: 09/17/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Inguinal hernias are common in premature infants, but there is substantial variation with regards to timing of repair. We sought to quantify and explain this variation. METHODS Cohort study of infants <34weeks gestation diagnosed with an inguinal hernia and discharged from one of 329 neonatal intensive units between 1998 and 2012. Multivariable logistic regression clustered by site was used to evaluate demographic, clinical, maternal, and socioeconomic variables associated with pre-discharge repair. RESULTS A total of 8037 infants met study criteria, and 3230 (40%) received a pre-discharge repair. The frequency of pre-discharge repair varied by site from 9% to 84%, and increased over the study period from 20% in 1998 to 45% in 2012. Concurrent gastrostomy or fundoplication and lower socioeconomic status were associated with an increased odds of receiving a pre-discharge repair. CONCLUSION There is substantial variation with regards to the timing of repair of inguinal hernias in premature infants, with an increasing number of infants receiving repair prior to hospital discharge over time. Concurrent gastrostomy or fundoplication and socioeconomic status are associated with timing of repair. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | - Rachel Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Marie Lynn Miranda
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Department of Statistics, Rice University, Houston, TX
| | - Martin L Blakely
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Henry E Rice
- Department of Surgery, Duke University Medical Center, Durham, NC; Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Obinna O Adibe
- Department of Surgery, Duke University Medical Center, Durham, NC; Department of Pediatrics, Duke University Medical Center, Durham, NC
| | | | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
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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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Oral A, Karaca L, Ahiskalioglu A, Yildiz A, Yigiter M, Celikkaya ME, Chyndolotov T, Salman AB. Effects of Laparoscopic Hernia Repair by PIRS (Percutan Internal Ring Suturing) Technique on Testicular Artery Blood Supply. J INVEST SURG 2018; 32:343-347. [PMID: 29393725 DOI: 10.1080/08941939.2017.1419317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: Percutaneous internal ring suturing technique (PIRS) is a minimally invasive technique in pediatric inguinal hernia repair. In the present study, a negative effect on testicular blood flow using PIRS technique has been investigated. Methods: Forty male patients were included in the study prospectively. Two groups were formed as conventional open surgery (Group I) and PIRS technique (Group II). The resistive index (RI) value of the testicular artery was measured prospectively by using SMI (superb micro-vascular imaging) software with the color doppler ultrasound technique preoperatively and postoperatively at the first month. Results: Inguinal hernia was present on the left in 35% (n = 14) of the patients and on the right in 65% (n = 26) of the patients. There was no statistically significant difference (p = 0.727) between Group I and II with regard to preoperative RI value (0.66 ± 0.07 vs. 0.66 ± 0.45, respectively). Similarly, there was no statistically significant difference (p = 0.220) between Group I and II with regard to the RI values measured at the postoperative first month (0.58 ± 0.04 vs. 0.60 ± 0.04, respectively). Although the postoperative RI values decreased compared to the preoperative values in both groups, this difference was not statistically significant. (p = 0.447 in Group I, and p = 0.175 in Group II for intragroup comparison). Conclusions: Besides PIRS technique has the advantages provided by all other laparoscopic techniques defined for inguinal hernia repair, there is no significant difference between this technique and conventional open surgery with regard to testicular blood flow. It is an innovative candidate technique instead of the open surgery method besides its additional advantages.
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Affiliation(s)
- Akgun Oral
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey.,e Department of Pediatric Surgery , Dr. Behcet Uz Children's Hospital , Izmir , Turkey
| | - Leyla Karaca
- b Department of Radiology , Ataturk University School of Medicine , Erzurum , Turkey
| | - Ali Ahiskalioglu
- c Department of Anesthesiology and Reanimation , Ataturk University School of Medicine , Erzurum , Turkey
| | - Abdullah Yildiz
- d Department of Pediatric Surgery , Sisli Etfal Training and Research Hospital , İstanbul , Turkey
| | - Murat Yigiter
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
| | - Mehmet Emin Celikkaya
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
| | - Temirlan Chyndolotov
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
| | - Ahmet Bedii Salman
- a Department of Pediatric Surgery , Ataturk University School of Medicine , Erzurum , Turkey
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Turkyilmaz Z, Sonmez K, Karabulut R, Demirogullari B, Ozen IO, Kapisiz A, Kale N, Basaklar AC. Incarcerated Inguinal Hernia in Children. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The aim of this study was to document the data of incarceration in a group of children with inguinal hernia and to investigate whether incarceration could have been prevented. Materials and methods A retrospective study reviewed the records of 3100 children who underwent herniorrhaphy between 1989 and 2007 in one centre, with 113 patients having hernia incarceration. In 16 patients, manual reduction was not attempted because of signs of strangulation, and in the remaining ones, reduction following sedation was not successful. The patients were evaluated with respect to age, postoperative mortality, and morbidity and especially whether he or she had been scheduled for operation in a surgical department. The incidence of incarcerated inguinal hernia and risk factors were analysed. Results Of the 113 patients with incarcerated inguinal hernia, 105 were boys (92.9%), with a male to female ratio of 13:1. The majority of the patients were under one year of age (n=73); and 47 were 0-3 months old. Three laparotomies, 7 small intestinal resection and primary anastomoses, 2 oophorectomy, 7 partial omentectomy and 8 appendectomies were performed. During the 6 months to 18 years follow-up, testicular atrophy was seen in 4 boys. Two babies died. Scrotal oedema, testicular atrophy and mortality rate were significantly higher in incarcerated hernia patients compared with those without incarceration (all with p=0.001). Conclusions Apparently, incarceration may be a preventable problem. Priority should be given to the treatment of inguinal hernias in infants less than 1 year of age, especially those 1-3 months old, as their risk of incarceration is higher.
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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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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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Al-Jazaeri A, Alshwairikh L, Aljebreen MA, AlSwaidan N, Al-Obaidan T, Alzahem A. Variation in access to pediatric surgical care among coexisting public and private providers: inguinal hernia as a model. Ann Saudi Med 2017; 37:290-296. [PMID: 28761028 PMCID: PMC6150598 DOI: 10.5144/0256-4947.2017.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Faced with growing healthcare demand, the Saudi government is increasingly relying on privatization as a tool to improve patient access to care. Variation in children's access to surgical care between public (PB) and private providers (PV) has not been previously analyzed. OBJECTIVES To compare access to pediatric surgical services between two coexisting PB and PV. DESIGN Retrospective comparative study. SETTINGS A major teaching hospital and the largest PV group in Saudi Arabia. PATIENTS AND METHODS The outcomes for children who underwent inguinal herniotomy (IH) between May 2010 and December 2014 at both providers were with IH serving as the model. Data collected included patient demographics, insurance coverage, referral pattern and access parameters including time-to-surgery (TTS), surgery wait time (SWT) and duration of symptoms (DOS). MAIN OUTCOME MEASURE(S) TTS, SWT and DOS. RESULTS Of 574 IH cases, 56 cases of in-hospital referrals were excluded leaving 290 PB and 228 PV cases. PV patients were younger (12.0 vs 16.4 months, P=.043) and more likely to be male (81.6% vs 72.8%, P=.019), expatriates (18% vs 3.4%, P < .001) and insured (47.4% vs 0%, P < .001). The emergency department was more frequently the source for PB referrals (35.2% vs 12.7%, P < .001) while most PV patients were self-referred (72.8% vs 16.7%, P < .001). Access parameters were remarkably better at PV: TTS (21 vs 66 days, P < .001), SWT (4 vs 31 days, P < .001) and DOS (33 vs 114 days, P < .001). CONCLUSION When coexisting, PV offers significantly better access to pediatric surgical services compared to PB. Diverting public funds to expand children's access to PV can be a valid choice to improve access to care in case when outcomes with the two providers are similar. LIMITATIONS Although it is the first and largest comparison in the pediatric population, the sample may not represent the whole population since it is confined to a single selected surgical condition.
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Affiliation(s)
- Ayman Al-Jazaeri
- Dr. Ayman Al-Jazaeri, Division of Pediatrc Surgery,, Department of Surgery,, King Saud University,, Riyadh 1355, Saudi Arabia, , ORCID: http://orcid.org/0000-0002-6853-0935
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Jobson M, Hall NJ. Current practice regarding timing of patent processus vaginalis ligation for idiopathic hydrocele in young boys: a survey of UK surgeons. Pediatr Surg Int 2017; 33:677-681. [PMID: 28424863 PMCID: PMC5434128 DOI: 10.1007/s00383-017-4085-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to determine the current UK practice regarding timing of surgical repair of hydroceles in young boys. METHODS Through a validated, online survey, participants were asked their preferred management option in five different clinical scenarios across five age ranges. RESULTS 71 responses were included in the analysis. The most common age to offer surgical intervention for a congenital hydrocele that is stable or increasing in size, or a hydrocele of the cord is 24-36 months. For a stable hydrocele presenting after 12 months of age, the most common age to offer repair is between 36 and 48 months. Approximately ¼ of respondents defer surgery until 4 years of age for any stable hydrocele. For a congenital hydrocele that is decreasing in size, the majority of respondents (57%) do not offer surgical intervention even over 4 years of age. The majority of respondents (61%) do not differentiate between communicating and non-communicating hydroceles when considering age for repair. CONCLUSION These results suggest that there is uncertainty regarding the optimum age for PPV ligation and adequate underlying variability in practice to support a prospective study of the optimum age for hydrocele repair and the natural history of PPV closure.
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Affiliation(s)
- Matthew Jobson
- grid.461841.eDepartment of Paediatric Surgery and Urology, Southampton Children’s Hospital, Southampton, UK
| | - Nigel J. Hall
- grid.461841.eDepartment of Paediatric Surgery and Urology, Southampton Children’s Hospital, Southampton, UK ,0000 0004 1936 9297grid.5491.9University Surgery Unit, Faculty of Medicine, MP 816, Southampton Children’s Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
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Choi BS, Byun GY, Hwang SB, Koo BH, Lee SR. A comparison between totally laparoscopic hydrocelectomy and scrotal incision hydrocelectomy with laparoscopic high ligation for pediatric cord hydrocele. Surg Endosc 2017; 31:5159-5165. [PMID: 28493163 DOI: 10.1007/s00464-017-5582-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study is to report clinical characteristics and to investigate the feasibility and safety of totally laparoscopic hydrocelectomy (TLH) compared to scrotal incision hydrocelectomy with laparoscopic high ligation (SIH) for pediatric cord hydrocele (CH). METHODS From September 2011 to February 2016, 148 patients underwent SIH, and 342 patients underwent TLH for CH. In the TLH group, a large hydrocele that could not pass through the internal ring was removed after percutaneous syringe aspiration. Age, laterality of hydrocele, inguinal comorbidities, operation time, surgical complications, and recurrences were evaluated. RESULTS All the patients had spermatic cord cysts and patent processus vaginalis in proximity to hydrocele (mixed type). The mean age of CH patients was 34.1 ± 22.1 months. CHs are more common on the right side (61.0%) than on the left (35.7%). Bilaterality occurred in 3.3%. Comorbidities such as hernia (8.6%) and cryptorchidism (1.2%) were observed. There were no complications except for two cases of wound hematoma in SIH group. There was one (0.7%) case of recurrence appeared in communicating hydrocele in SIH group. There were no significant differences in the age, laterality of hydrocele, inguinal comorbidities, operation time, complications, and recurrences between TLH and SIH groups. However, TLH for unilateral cord hydrocele had significantly shorter operation time compared to SIH. The mean operation time in TLH group was 15.6 ± 5.96 min and there was no conversion to open surgery. CONCLUSIONS TLH for pediatric CH is a feasible and safe procedure without additional incisions. Therefore, TLH can be one of the surgical options for pediatric CH especially in mixed type.
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Affiliation(s)
- Byung Seo Choi
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
| | - Geon Young Byun
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
| | - Seong Bae Hwang
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
| | - Bum Hwan Koo
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea
| | - Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, 213 Bongeunsa-ro, Gangnam-gu, Seoul, Korea.
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Chin EL, Troncoso R, Shimkaveg M, Dietz E. Labial Mass in an Irritable 35-Day-Old Female. Clin Pediatr (Phila) 2017; 56:492-495. [PMID: 27149988 DOI: 10.1177/0009922816646724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erica L Chin
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruben Troncoso
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan Shimkaveg
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edith Dietz
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes.
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Affiliation(s)
- Jeremiah Smith
- Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA.
| | - Sean M Fox
- Emergency Medicine Residency Program, Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA
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Comparative study between purse–string suture and peritoneal disconnection with ligation techniques in the laparoscopic repair of inguinal hernia in infants and children. ANNALS OF PEDIATRIC SURGERY 2016. [DOI: 10.1097/01.xps.0000481344.06100.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Esposito C, Escolino M, Turrà F, Roberti A, Cerulo M, Farina A, Caiazzo S, Cortese G, Servillo G, Settimi A. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg 2016; 25:232-40. [PMID: 27521714 DOI: 10.1053/j.sempedsurg.2016.05.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. This article reviews current concepts in the management of inguinal hernia and hydrocele based on the recent literature and the authors׳ experience. We describe the principles of clinical assessment and anesthetic management of children undergoing repair of inguinal hernia, underlining the differences between an inguinal approach and minimally invasive surgery (MIS). Other points discussed include the current management of particular aspects of these pathologies such as bilateral hernias; contralateral patency of the peritoneal processus vaginalis; hernias in premature infants; direct, femoral, and other rare hernias; and the management of incarcerated or recurrent hernias. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele, emphasizing that the current use of MIS in pediatric patients has completely changed the management of pediatric inguinal hernias.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131.
| | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Francesco Turrà
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Agnese Roberti
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Mariapina Cerulo
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Alessandra Farina
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
| | - Simona Caiazzo
- Department of Anesthesiology, Federico II University, Naples, Italy
| | - Giuseppe Cortese
- Department of Anesthesiology, Federico II University, Naples, Italy
| | | | - Alessandro Settimi
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, Naples, Italy 80131
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Panabokke G, Clifford ID, Craig SS, Nataraja RM. Reduction of paediatric inguinal hernias. Emerg Med Australas 2016; 28:224-7. [PMID: 26968864 DOI: 10.1111/1742-6723.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gayathri Panabokke
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia
| | | | - Simon S Craig
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Le Roux F, Lipsker A, Mesureur S, Haraux E. Inguinal hernia repair in children: Surgical technique. J Visc Surg 2016; 153:121-5. [PMID: 26838931 DOI: 10.1016/j.jviscsurg.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- F Le Roux
- Service de chirurgie digestive et métabolique, CHU d'Amiens, université Picardie Jules-Verne, 80000 Amiens, France.
| | - A Lipsker
- Service de chirurgie urologique et transplantation, CHU d'Amiens, université Picardie Jules-Verne, 80000 Amiens, France
| | - S Mesureur
- Service de chirurgie infantile, CHU d'Amiens, université Picardie Jules-Verne, 80000 Amiens, France
| | - E Haraux
- Service de chirurgie infantile, CHU d'Amiens, université Picardie Jules-Verne, 80000 Amiens, France
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Hughes K, Horwood JF, Clements C, Leyland D, Corbett HJ. Complications of inguinal herniotomy are comparable in term and premature infants. Hernia 2016; 20:565-9. [DOI: 10.1007/s10029-015-1454-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
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Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs. Hernia 2015; 20:571-7. [PMID: 26667260 PMCID: PMC4945679 DOI: 10.1007/s10029-015-1447-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
Purpose Inguinal hernia repair is frequently performed in premature infants. Evidence on optimal management and timing of repair, as well as related medical costs is still lacking. The objective of this study was to determine the direct medical costs of inguinal hernia, distinguishing between premature infants who had to undergo an emergency procedure and those who underwent elective inguinal hernia repair. Methods This cohort study based on medical records concerned premature infants with inguinal hernia who underwent surgical repair within 3 months after birth in a tertiary academic children’s hospital between January 2010 and December 2013. Two groups were distinguished: patients with incarcerated inguinal hernia requiring emergency repair and patients who underwent elective repair. Real medical costs were calculated by multiplying the volumes of healthcare use with corresponding unit prices. Nonparametric bootstrap techniques were used to derive a 95 % confidence interval (CI) for the difference in mean costs. Results A total of 132 premature infants were included in the analysis. Emergency surgery was performed in 29 %. Costs of hospitalization comprised 65 % of all costs. The total direct medical costs amounted to €7418 per premature infant in the emergency repair group versus €4693 in the elective repair group. Multivariate analysis showed a difference in costs of €1183 (95 % CI −1196; 3044) in favor of elective repair after correction for potential risk factors. Conclusion Emergency repair of inguinal hernia in premature infants is more expensive than elective repair, even after correction for multiple confounders. This deserves to be taken into account in the debate on timing of inguinal hernia repair in premature infants.
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Nazem M, Dastgerdi MMH, Sirousfard M. Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2015; 20:1172-6. [PMID: 26958052 PMCID: PMC4766824 DOI: 10.4103/1735-1995.172985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/04/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Considering that complications and outcome of each method of pediatric inguinal hernia repair are one of the determinants for pediatric surgeons for selection of the appropriate surgical technique, we compared the early and late complications of two inguinal repair techniques, with and without opening the external oblique muscle fascia. MATERIALS AND METHODS In this double-blind clinical trial study, boy children aged 1-month to 6 years with diagnosed inguinal hernia were included and randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal edema and hematoma, and wound infections classified as early complication and recurrence, testis atrophy and sensory impairment of inguinal area classified as late complications. The rates of mentioned early and late complications were compared in the two interventional groups. RESULTS In this study, 66 patients were selected and allocated to the two interventional groups. The prevalence of early and late complications in two studied groups were not different significantly in two interventional groups (P > 0.05). Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied technique (P = 0.001). CONCLUSION The findings of our study indicated that though early and late complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle, which considered the superiority of this method than inguinal hernia repair with opening the external oblique muscle.
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Affiliation(s)
- Masoud Nazem
- Department of Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Motaherh Sirousfard
- Department of Pediatric Nursing, Isfahan University of Medical Sciences, Isfahan, Iran
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Pini Prato A, Rossi V, Mosconi M, Disma N, Mameli L, Montobbio G, Michelazzi A, Faranda F, Avanzini S, Buffa P, Ramenghi L, Tuo P, Mattioli G. Inguinal hernia in neonates and ex-preterm: complications, timing and need for routine contralateral exploration. Pediatr Surg Int 2015; 31:131-6. [PMID: 25381589 DOI: 10.1007/s00383-014-3638-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Aim of this study was to present a series of neonates and ex-preterm babies who underwent inguinal hernia repair focusing on complications and possible indication to perform routine contralateral groin exploration. METHODS This is a retrospective study of a series of consecutive patients weighing less than 5 kg who underwent inguinal hernia repair between January 2007 and December 2012. Only the affected side was treated. Patients have been routinely followed up postoperatively. We resorted to available outpatients' charts and admission notes to record demographic data, surgical details, complications and the occurrence of metachronous hernias. A questionnaire was administered to all patients' relatives to confirm the long-term outcome. RESULTS One hundred fifty-four patients were operated for a total of 184 herniotomies (88 right sided, 36 left sided and 30 bilateral). Median length of follow-up was 42 months (range 6 months-7.5 years). Thirteen patients (13/124 = 10.5 %) developed metachronous hernia that proved to be significantly more frequent in patients weighing less than 1,500 g at birth (p < 0.05). We observed 10 % of complications, including 2.7 % testicular atrophy and 4.5 % recurrence. Atrophy proved to occur more frequently in patients who experienced preoperative incarceration (p < 0.05). No other risk factors were identified. CONCLUSIONS The results of our series demonstrated that, though technically demanding, herniotomy in the neonate and ex-preterm is associated with a relatively low incidence of complications. Based on our results and in accordance with literature data, we do not advocate routine contralateral exploration in case of unilateral hernia but surgery to be performed only on the symptomatic side, as soon as possible after initial diagnosis. Very low birth weight patients should be followed with care in the early postoperative period due to the higher likelihood of developing a metachronous hernia.
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Affiliation(s)
- A Pini Prato
- Paediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy,
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Ibrahim M, Getso KI, Mohammad MA, Akhparov NN, Aipov RR. Herniotomy in resource-scarce environment: Comparison of incisions and techniques. Afr J Paediatr Surg 2015; 12:45-50. [PMID: 25659550 PMCID: PMC4955508 DOI: 10.4103/0189-6725.150980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are various methods for surgical treatment of hernia and hydrocele in children with variable cost-effectiveness, recovery and cosmetic outcomes. This study analyses our experience with mini-incision/invasive herniotomy in children in resource-limited centre. MATERIALS AND METHODS Seven hundred and eighty-four n = 784 patients underwent herniotomy via conventional and mini-invasive methods were assigned into Group A and Group B. Three hundred and seventy-six n = 376 (47.95%) in Group A while four hundred and eight n = 408 (52.04%) in Group B. Eight hundred and seventeen (817) herniotomy was performed. Demographic data, hernia/hydrocele sides, volume of surgical suture used, surgery duration, and complications analysed. RESULTS Right side hernia and/or hydrocele were 464 (59.18%). 287 (36.60%) had left sided while 33 (4.21%) had bilateral hernia and/or hydrocele. There were 14 bilateral hernia repair in Group A and 19 in Group B. The lengths of operation time for unilateral repair ranged from 14 to 54 min in Group A (median, 23 min) and 7-44 min in Group B (median, 15 min) with a mean surgical duration of 15.48 ± 4.16 min in Group B versus 23.41 ± 5.94 min in Group A (P < 0.001) while the range of the lengths of operation time for bilateral repair in Group A was 20-54 min (median, 36) and 12-30 min (median, 21) in Group B with a mean duration of 36.35 ± 9.89 min in Group A versus 20.42 ± 4.83 min in Group B P = 0.00563. 376 sachets of 45 cm suture material were used in Group A versus 137 in Group B. There were total of 87 (23.13%) complications in Group A versus 3 (1.47%) in Group B P = 0.000513. Superficial wound infection and abscess were 9 (2.36%) and 16 (4.25%) in Group A versus none (0) in Group B. CONCLUSION Mini-incision/invasive herniotomy in children and adolescents is fast, cost-effective with satisfactory cosmetic outcome and limited complications.
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Affiliation(s)
- Musa Ibrahim
- Department of Surgery, Murtala Mohammad Specialist Hospital, Children Surgical Unit, Kano, Nigeria
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Crankson SJ, Al Tawil K, Al Namshan M, Al Jadaan S, Baylon BJ, Gieballa M, Ahmed IH. Management of inguinal hernia in premature infants: 10-year experience. J Indian Assoc Pediatr Surg 2015; 20:21-4. [PMID: 25552826 PMCID: PMC4268751 DOI: 10.4103/0971-9261.145440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM Debatable issues in the management of inguinal hernia in premature infants remain unresolved. This study reviews our experience in the management of inguinal hernia in premature infants. MATERIALS AND METHODS Retrospective chart review of premature infants with inguinal hernia from 1999 to 2009. Infants were grouped into 2: Group 1 had repair (HR) just before discharge from the neonatal intensive care unit (NICU) and Group 2 after discharge. RESULTS Eighty four premature infants were identified. None of 23 infants in Group 1 developed incarcerated hernia while waiting for repair. Of the 61 infants in Group 2, 47 (77%) underwent day surgery repair and 14 were admitted for repair. At repair mean postconceptional age (PCA) in Group1 was 39.5 ± 3.05 weeks. Mean PCA in Group 2 was 66.5 ± 42.73 weeks for day surgery infants and 47.03 ± 8.87 weeks for admitted infants. None of the 84 infants had an episode of postoperative apnea. Five (5.9%) infants presented subsequently with metachronous contralateral hernia and the same number of infants had hernia recurrence. CONCLUSIONS Delaying HR in premature infants until ready for discharge from the NICU allows for repair closer to term without increasing the risk of incarceration. Because of low occurrence of metachronous hernia contralateral inguinal exploration is not justified. Day surgery HR can be performed in former premature infant if PCA is >47 weeks without increasing postoperative complications.
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Affiliation(s)
| | - Khalil Al Tawil
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Mohammad Al Namshan
- Department of Surgery, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Saud Al Jadaan
- Department of Surgery, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Beverly Jane Baylon
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Mutaz Gieballa
- Department of Surgery, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Ibrahim Hakim Ahmed
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
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Preoperative ultrasonographic evaluation of the contralateral patent processus vaginalis at the level of the internal inguinal ring is useful for predicting contralateral inguinal hernias in children: a prospective analysis. Hernia 2014; 19:595-8. [DOI: 10.1007/s10029-014-1317-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022]
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Primary new-onset hydroceles presenting in late childhood and pre-adolescent patients resemble the adult type hydrocele pathology. J Pediatr Surg 2014; 49:1656-8. [PMID: 25475813 DOI: 10.1016/j.jpedsurg.2014.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/04/2014] [Accepted: 05/13/2014] [Indexed: 11/22/2022]
Abstract
AIM The aim of this study was to investigate the presence of a patent processus vaginalis (PPV) in children of late childhood and pre-adolescence presenting with new onset hydrocele. MATERIAL AND METHODS All males with hydrocele presenting at our department from January 2011 to January 2013 were followed. Patients with secondary hydroceles were excluded. Demographic data, medical history, clinical symptoms and signs relative to their pathology and U/S findings were recorded. According to their indications, patients were either operated or followed up. Patients surgically treated, consisted our study group. RESULTS Sixty patients were identified. Thirteen were followed until resolution of their hydrocele. Forty-seven patients were surgically treated. Twenty-seven had right sided hydrocele (57.44%), 13 had left sided hydrocele (27.66%) whereas in 7 patients the hydroceles were bilateral (14.9%). All patients were operated by an inguinal approach. In all 9 patients (19.14%) presenting with new-onset hydrocele at the age >10 years (range: 10-15 years), intraoperative exploration did not reveal a PPV. All patients were followed at least for 6 months post-operatively. CONCLUSION Early evidence shows that primary new onset hydroceles presenting in late childhood and pre-adolescence seem to be non-communicating and resemble the adult type hydrocele pathology.
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Incarcerated inguinal hernia management in children: 'a comparison of the open and laparoscopic approach'. Pediatr Surg Int 2014; 30:621-4. [PMID: 24805115 DOI: 10.1007/s00383-014-3507-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the outcomes of management of incarcerated inguinal hernia by open versus laparoscopic approach. METHODS This is a retrospective analysis of incarcerated inguinal hernina in a paediatric surgery centre involving four consultants. Manual reduction was attempted in all and failure was managed by emergency surgery. RESULTS The laparoscopy group had 27 patients. Four patients failed manual reduction and underwent emergency laparoscopic surgery. Three of them had small bowel strangulation which was reduced laparoscopically. The strangulated bowel was dusky in colour initially but changed to normal colour subsequently under vision. The fourth patient required appendectomy for strangulated appendix. One patient had concomitant repair of umbilical hernia and one patient had laparoscopic pyloromyotomy at the same time. One patient had testicular atrophy, one had hydrocoele and one had recurrence of hernia on the asymptomatic side. The open surgery group had 45 patients. Eleven patients had failed manual reduction requiring emergency surgery, of these two required resection and anastomosis of small intestine. One patient in this group had concomitant repair of undescended testis. There was no recurrence in this group, one had testicular atrophy and seven had metachronous hernia. CONCLUSIONS Both open herniotomy and laparoscopic repair offer safe surgery with comparable outcomes for incarcerated inguinal hernia in children. Laparoscopic approach and hernioscopy at the time of open approach appear to show the advantage of repairing the contralateral patent processus vaginalis at the same time and avoiding metachronous inguinal hernia.
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Gawad N, Davies DA, Langer JC. Determinants of wait time for infant inguinal hernia repair in a Canadian children's hospital. J Pediatr Surg 2014; 49:766-9. [PMID: 24851766 DOI: 10.1016/j.jpedsurg.2014.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 02/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Longer wait time for infant inguinal hernia (IH) repair is associated with higher complication rates. We wished to determine if socioeconomic and demographic factors influence wait times for IH repair. METHODS Children <2 years old with IH at a Canadian children's hospital were retrospectively reviewed. Days from diagnosis to surgical consultation (W1) and from consultation to repair (W2) were collected along with demographic, medical, and socioeconomic data. Linear regression analysis was performed. RESULTS A total of 131 patients were appropriate for analysis (82.4% male). Median distance to hospital was 27.5 km (IQR=10.5-50.4) and median income was $34,477 (IQR=30,127-41,986). Median W1, W2, and Wtotal (W1+W2) were 24 (IQR=8-48), 43 (IQR=21-69) and 79 (IQR=38-112) days, respectively. Wait times were shorter in infants who were male (p=0.044), symptomatic (p<0.001), diagnosed in the ED (p<0.001), or had an incarcerated hernia (p=0.006). They were longer for premature infants (p=0.009) and those with significant comorbidities (p=0.018). Neither income (p=0.328) nor distance from hospital (p=0.292) was associated with longer wait times. CONCLUSION Wait times for IH repair were appropriately influenced by medical risk factors. Income and distance to hospital did not appear to influence wait times. A population-based study is needed to determine if these findings reflect a general trend within the Canadian health care system.
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Affiliation(s)
- Nada Gawad
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Dafydd A Davies
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jacob C Langer
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
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Lee CH, Boo YJ, Lee EH. Long-term Outcome of Laparoscopic Hernia Sac Transection and Intracorporeal Ligation in Children: A Single Center Cohort Study. ACTA ACUST UNITED AC 2014. [DOI: 10.13029/jkaps.2014.20.2.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chang Hun Lee
- Division of Pediatric Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Jung Boo
- Division of Pediatric Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Eun Hee Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
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Alp BF, Irkilata HC, Kibar Y, Zorba U, Sancaktutar AA, Kaya E, Dayanc M. Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children. Kaohsiung J Med Sci 2013; 30:200-5. [PMID: 24656161 DOI: 10.1016/j.kjms.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/09/2013] [Indexed: 11/19/2022] Open
Abstract
The inguinal approach is used for the treatment of hydrocele in the pediatric population. Although studies on scrotal orchiopexy have mentioned hernia or hydrocele repair through the same scrotal incision as a part of an orchiopexy procedure, there are a few studies reporting the treatment of isolated communicating hydrocele through a scrotal incision. We retrospectively evaluated and compared the outcomes of inguinal and scrotal approaches for the treatment of communicating hydrocele in boys. The classical inguinal and scrotal approaches to the treatment of communicating hydrocele were performed on 46 and 30 testicular units (in 43 boys and 27 boys, respectively). The patients' charts were reviewed to assess the operative times as well as the immediate and long-term complications during follow-up periods. The patients' ages ranged from 1 year to 8 years (3.6 ± 2.0 years) in the inguinal group and from 1 year to 10 years (mean 4.6 ± 2.8 years) in the scrotal group. Operative time was significantly lower in the scrotal group (p < 0.0001). The early minor complication rate did not differ between the two groups. Furthermore, there were no major complications noted. None of the patients had hydrocele recurrence after a mean follow-up of 6 months. The advantages of the scrotal approach for the treatment of communicating hydrocele are as follows: it is well tolerated, simple, and cosmetically appealing, and it has a short operative time in comparison with the standard inguinal approach. The scrotal incision technique is an effective alternative in communicating hydrocele treatment.
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Affiliation(s)
| | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Unal Zorba
- School of Medicine, Rize University, Rize, Turkey
| | | | - Engin Kaya
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Murat Dayanc
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
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van Heurn LWE, Pakarinen MP, Wester T. Contemporary management of abdominal surgical emergencies in infants and children. Br J Surg 2013; 101:e24-33. [PMID: 24338775 DOI: 10.1002/bjs.9335] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute abdominal complaints in children are common presentations in the emergency department. The aetiology, presentation, diagnosis and management often differ from those in adults. METHODS This review was based on expert paediatric surgical experience confirmed by evidence from the literature obtained by searching PubMed and the Cochrane Library. Keywords used were the combinations of 'abdominal emergencies', 'acute abdomen' and the disorders 'acute appendicitis', 'intussusception', 'volvulus', 'Meckel's diverticulum', 'incarcerated inguinal hernia', 'testicular torsion' and 'ovarian torsion' with 'children'. Information was included from reviews, randomized clinical trials, meta-analyses, and prospective and retrospective cohort studies. RESULTS Presentation and symptoms of abdominal emergencies, especially in young children, vary widely, which renders recognition of the underlying disorder and treatment challenging. Critically targeted imaging techniques are becoming increasingly important in obtaining the correct diagnosis without unnecessary delay. Minimally invasive techniques have become the method of choice for the diagnosis and treatment of many abdominal emergencies in children. CONCLUSION Knowledge of abdominal disorders in childhood, their specific presentation, diagnosis and treatment facilitates management of children with acute abdomen in emergency departments. Imaging and minimally invasive techniques are becoming increasingly important in the diagnosis of acute abdomen in children. Urgent operation remains the cornerstone of therapy for most acute abdominal disorders.
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Affiliation(s)
- L W E van Heurn
- Departments of Paediatric Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Hoshino M, Sugito K, Kawashima H, Goto S, Kaneda H, Furuya T, Hosoda T, Masuko T, Ohashi K, Inoue M, Ikeda T, Tomita R, Koshinaga T. Prediction of contralateral inguinal hernias in children: a prospective study of 357 unilateral inguinal hernias. Hernia 2013; 18:333-7. [PMID: 23644774 PMCID: PMC4037557 DOI: 10.1007/s10029-013-1099-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 04/26/2013] [Indexed: 11/26/2022]
Abstract
Purpose Previously, we established a pre-operative risk scoring system to predict contralateral inguinal hernia in children with unilateral inguinal hernias. The current study aimed to verify the usefulness of our pre-operative scoring system. Methods This was a prospective study of patients undergoing unilateral inguinal hernia repair from 2006 to 2009 at a single institution. Gender, age at initial operation, birth weight, initial operation side, and the pre-operative risk score were recorded. We analyzed the incidence of contralateral inguinal hernia, risk factors, and the usefulness of our pre-operative risk scoring system. The follow-up period was 36 months. We used forward multiple logistic regression analysis to predict contralateral hernia. Results Of the 372 patients who underwent unilateral hernia repair, 357 (96.0 %) were completely followed-up for 36 months, and 23 patients (6.4 %) developed a contralateral hernia. Left-sided hernia (OR = 5.5, 95 %, CI = 1.3–24.3, p = 0.023) was associated with an increased risk of contralateral hernia. The following covariates were not associated with contralateral hernia development: gender (p = 0.702), age (p = 0.215), and birth weight (p = 0.301). The pre-operative risk score (cut-off point = 4.5) of the patients with a contralateral hernia was significantly higher, compared with the patients without a contralateral hernia using the area under the receiver operating characteristic curve (p = 0.024). Conclusions Using multivariate analysis, we confirmed usefulness of our pre-operative scoring system and initial side of the inguinal hernia, together, for the prediction of contralateral inguinal hernia in children.
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Affiliation(s)
- M. Hoshino
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - K. Sugito
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - H. Kawashima
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - S. Goto
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - H. Kaneda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Furuya
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Hosoda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Masuko
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - K. Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - M. Inoue
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Ikeda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - R. Tomita
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
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Bisgaard T, Kehlet H, Oehlenschlager J, Rosenberg J. Acceptable nationwide outcome after paediatric inguinal hernia repair. Hernia 2013; 18:325-31. [DOI: 10.1007/s10029-013-1077-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
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48
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Elective procedures and anesthesia in children: pediatric surgeons enter the dialogue on neurotoxicity questions, surgical options, and parental concerns. J Neurosurg Anesthesiol 2013; 24:396-400. [PMID: 23085786 DOI: 10.1097/ana.0b013e31826a032d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Pediatric Anesthesia NeuroDevelopment Assessment research group at Columbia University Medical Center Department of Anesthesiology has conducted biannual national Symposia since 2008 to evaluate study data and invigorate continued thinking about unresolved issues of pediatric anesthesia neurotoxicities. The third Symposium extended the dialogue between pediatric anesthesiologists and surgeons in panel presentations and discussions by four surgical specialists. This paper reports the prevailing opinions expressed by a pediatric general surgeon, urologist, plastic surgeon and ophthalmologist and explores factors related to delayed operative intervention, need for multiple procedures, and parental concerns.
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49
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Abstract
A 2.5-month-old girl with a left-sided, painful inguinal swelling for the last 2 days was brought to the emergency department. After physical examination and radiological evaluation, the diagnosis of incarcerated inguinal hernia of the ovary was made. Because of the long-standing history, she was taken to the operation room without an attempt for manual reduction. Perioperatively, the torsion of the ovary with distal fallopian tube within the indirect hernia sac was seen. As untwisting of the ovary has resulted in no change in the color, oophorectomy before hernia repair was performed.The majority of the painful inguinal swellings in the infancy are related to incarcerated hernia. The treatment option varies from manual reduction to surgical intervention, depending on the duration from beginning of swelling to the time the exact diagnosis was made. Even though the presence of short-term history and the lack of peritoneal irritation findings are indications for a manual reduction, the suspicion of an ovarian torsion should be raised for ovaries within the incarcerated inguinal hernia, and ovarian viability should be considered before an attempt of manual reduction.
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50
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Shehata SMK, El Attar AA, Attia MA, Hassan AM. Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country. Hernia 2012; 17:229-34. [PMID: 23269403 DOI: 10.1007/s10029-012-1031-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 12/08/2012] [Indexed: 12/29/2022]
Abstract
PURPOSE We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources. METHODS Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed. RESULTS We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months. CONCLUSIONS Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.
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Affiliation(s)
- S M K Shehata
- Department of Pediatric Surgery, Tanta University Hospital, 12th El-Motawakel Street, Flat No.1, Tanta El-Gidida, Tanta, 31111, Egypt.
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