Further Experience with Bilateral Operations for Inguinal Hernia in Infants and Children

Simpson, Thomas; Gunnlaugsson, Gunnar H.; Dawson, B.; Lynn, Hugh B.

doi:10.1097/00000658-196903000-00023

Cited by 16 publications

(6 citation statements)

References 4 publications

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“…Complications including testicular atrophy, hydrocele, hematoma, wound infection, apnea and recurrence were described by thirteen studies and reported to be found in 1.97% ([95% CI 0.98 to 3.29; I 2 =81.03) of 3230 patients 36,37,[40][41][42]44,48,50,51,53,[55][56][57] . Six studies (n=1096 patients) reported that contralateral exploration increases the total anesthesia time by on average 15-20 minutes 40,41,45,47,51,55 .…”

Section: Resultsmentioning

confidence: 99%

“…[33][34][35][36][37]39,40,46,47,54,55 Complications including testicular atrophy, hydrocele, hematoma, wound infection, apnea, and recurrence were described by 13 studies and reported to be found in 1.97% ([95% CI: 0.98-3.29; I 2 ¼ 81.03) of 3,230 patients. 33,34,[37][38][39]41,45,47,48,50,[52][53][54] Six studies (n ¼ 1,096 patients) reported that contralateral exploration increases the total anesthesia time by on average 15 to 20 minutes. 37,38,42,44,48,52 Mean values with the corresponding standard deviations of both unilateral repair and unilateral repair with contralateral exploration were not reported.…”

Section: Resultsmentioning

confidence: 99%

“…Pooled estimate of positive contralateral exploration rates showed that the processus vaginalis was found to be patent in 63.49% ([95% CI: 56.88–69.87], I 2 = 95.76%). 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Pooled estimates of 11 studies ( n = 3,008 patients) evaluating the results of patients who did not undergo contralateral exploration, showed that MCIH developed in 8.4% ([95% CI: 5.48–11.90], I 2 = 85.88%; Table 4 ). 33 34 35 36 37 39 40 46 47 54 55…”

Section: Resultsmentioning

confidence: 99%

“…33 34 37 38 39 41 45 47 48 50 52 53 54 Six studies ( n = 1,096 patients) reported that contralateral exploration increases the total anesthesia time by on average 15 to 20 minutes. 37 38 42 44 48 52 Mean values with the corresponding standard deviations of both unilateral repair and unilateral repair with contralateral exploration were not reported. Furthermore, in patients who underwent unilateral hernia repair and subsequent second surgery following development of MCIH, the duration of surgery was not reported.…”

Section: Resultsmentioning

confidence: 99%

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Surgical Management of Pediatric Inguinal Hernia: A Systematic Review and Guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee

et al. 2021

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Introduction Inguinal hernia repair represents the most common operation in childhood; however, consensus about the optimal management is lacking. Hence, recommendations for clinical practice are needed. This study assesses the available evidence and compiles recommendations on pediatric inguinal hernia. Materials and Methods The European Pediatric Surgeons' Association Evidence and Guideline Committee addressed six questions on pediatric inguinal hernia repair with the following topics: (1) open versus laparoscopic repair, (2) extraperitoneal versus transperitoneal repair, (3) contralateral exploration, (4) surgical timing, (5) anesthesia technique in preterm infants, and (6) operation urgency in girls with irreducible ovarian hernia. Systematic literature searches were performed using PubMed, MEDLINE, Embase (Ovid), and The Cochrane Library. Reviews and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Results Seventy-two out of 5,173 articles were included, 27 in the meta-analyses. Laparoscopic repair shortens bilateral operation time compared with open repair. In preterm infants, hernia repair after neonatal intensive care unit (NICU)/hospital discharge is associated with less respiratory difficulties and recurrences, regional anesthesia is associated with a decrease of postoperative apnea and pain. The review regarding operation urgency for irreducible ovarian hernia gained insufficient evidence of low quality. Conclusion Laparoscopic repair may be beneficial for children with bilateral hernia and preterm infants may benefit using regional anesthesia and postponing surgery. However, no definite superiority was found and available evidence was of moderate-to-low quality. Evidence for other topics was less conclusive. For the optimal management of inguinal hernia repair, a tailored approach is recommended taking into account the local facilities, resources, and expertise of the medical team involved.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Surgical Management of Pediatric Inguinal Hernia: A Systematic Review and Guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee

et al. 2021

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“…Surgeons operating on unilateral hernia in infants and young children found that if the unaffected side is also explored a patent processus vaginalis, capable of becoming a hernia, is found in from 40 to 70 per cent of patients (Gilbert and Clatworthy, 1959;Gunnlaugsson, Dawson, and Lynn, 1967;Solomon, 1967 j Simpson, Gunnlaugsson, and Lynn, 1969).…”

Section: Fig 3-the Deep Inguinal Ring Opening Viewed From Behindmentioning

confidence: 99%

The deep inguinal ring, development, function and repair

Lytle¹

1970

Journal of British Surgery

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The deep inguinal ring opening, due to the outgrowth of the processus vaginalis around the gubernaculum, appears at the end of the 2nd month of foetal life. Around this opening the U-shaped ring of transversalis fascia begins to develop about the 5th month. The U-shaped ring is well formed and its valvular design established at the 7th month. Descent of the testis usually takes place during the 7th or 8th month of intra-uterine life, but the processus vaginalis, which should normally close before or soon after birth, may remain open throughout life. The pressure valve of the deep inguinal ring, with its active closure mechanism, is capable of protecting an open processus vaginalis, often for months or years, against the onset of a hernia. The need to join together cut or raw edges to give sound union is emphasized and the indications for ring repair in oblique hernia and major repair in direct hernia are outlined.

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Inguinal herniotomy in children: A five year survey

Harvey

Johnstone

Fossard

1985

Journal of British Surgery

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This retrospective review covers our experience over 5 years of 436 hernia repairs in 392 children upto the age of 15 years. The number of emergency presentations was 71 (18.1 per cent) and 66.2 per cent of these were under the age of 12 months. Most cases were initially treated conservatively and only 18 children required operation on the day of admission. There were 11 recurrences (7 elective and 4 emergency cases) giving a recurrence rate of 2.5 per cent. In all eleven cases the original operation was performed by a junior surgeon. The complication rate (excluding recurrences) was 2.8 per cent but may be an underestimate because of the limitations of a retrospective study. We suspect our results are typical of those to be found in any large British hospital and that with careful training and supervision of junior staff in the technique of inguinal herniotomy the results could be improved and approach those found in specialist paediatric units in America.

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Further Experience with Bilateral Operations for Inguinal Hernia in Infants and Children

Cited by 16 publications

References 4 publications

Surgical Management of Pediatric Inguinal Hernia: A Systematic Review and Guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee

Surgical Management of Pediatric Inguinal Hernia: A Systematic Review and Guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee

The deep inguinal ring, development, function and repair

Inguinal herniotomy in children: A five year survey

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