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Martucci C, Frediani S, Accinni A, Aloi IP, Bertocchini A, Crocoli A, Madafferi S, Pardi V, Persano G, Inserra A. Femoral hernia in pediatric population: a diagnostic and surgical challenge. Hernia 2024; 28:593-597. [PMID: 38270834 DOI: 10.1007/s10029-023-02953-2] [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: 08/09/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Femoral hernia (FH) is a rare and often misdiagnosed pathology in pediatric population. The aim of our study was to describe the experience of a Tertiary Center in children with FH, underlying diagnostic and surgical details that could improve its management. METHODS A retrospective study of pediatric patients who underwent FH repair from January 2010 to June 2023 at our Institution was performed. RESULTS In the analyzed period, 31 patients underwent surgical procedure for FH at our institution, of whom 16 (51.6%) were female. The mean age at time of surgery was 5.8 years (range 0.5-17.1 years). The rate of pre-operative misdiagnosis was 35.5% and open approach was adopted in all cases (16.1% with mesh application). Only two patients (6.4%) experienced surgical complications: one recurrence (repaired six months later) and one post-operative hematoma (treated successfully with conservative method). CONCLUSION Due to the high rate of misdiagnosis, the variety of surgical approaches proposed, and the potential for intraoperative complications, FH poses a challenge for pediatric surgeons and urologists, as confirmed by the literature. It is essential to underline the importance of a proper clinical examination in order to correctly diagnose FH, make the best surgical plan for the patient and prevent post-operative complications.
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Affiliation(s)
- Cristina Martucci
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy.
| | - Simone Frediani
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Antonella Accinni
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Ivan Pietro Aloi
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Arianna Bertocchini
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Alessandro Crocoli
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Madafferi
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valerio Pardi
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Giorgio Persano
- Department of Surgery, Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Inserra
- Department of Surgery, General and Thoracic Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
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Chen AL, Wilhelm S, Sobolic M, Brahmamdam P, Akay B, Novotny NM. Laparoscopic Repair of Pediatric Femoral Hernias. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38442225 DOI: 10.1089/lap.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background: Current rates of reported pediatric femoral hernias remain exceedingly low, with their incidence reported to be <1%. The mainstay of repair has traditionally been through an open approach, and pediatric surgeons remain reluctant to repair otherwise. Owing to its rarity, consensus regarding management remains absent. Because of this, we present a scoping review on the use of laparoscopy and minimally invasive techniques to repair pediatric femoral hernias. Methods: A scoping literature review was performed using PubMed, Embase, Scopus, and Web of Science for related articles (keywords). Full-text articles and abstracts were then reviewed for relevance using inclusion and exclusion criteria with data extracted from each piece. Results: The search identified 268 articles published from 1992 to 2023. Eleven articles met our inclusion criteria. After reviewing their content, a total of 87 patients were identified. Of these, 42 laparoscopic repairs were reported. Three primary laparoscopic surgical techniques were described, with no recurrence reported. Conclusion: Laparoscopy remains a viable tool in diagnosing and managing femoral hernias. Various technically feasible options for laparoscopy and minimally invasive techniques have been described with excellent results and limited recurrence. However, given the quality of the data, further studies are needed to investigate the long-term durability of such repairs.
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Affiliation(s)
- Alexander L Chen
- Department of General Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Spencer Wilhelm
- Department of General Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Michael Sobolic
- Department of General Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Pavan Brahmamdam
- Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
| | - Begum Akay
- Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
| | - Nathan M Novotny
- Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
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