Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia

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.

Comparison of Ferguson and Gross herniotomy with Mitchell Banks’ herniotomy in boys older than two years

“…Studies have documented the inguinal canal length in a range of 4-23mm to a maximum of 40-50mm, an average of 0.7-1.9 cm in children younger than 13 years. 9 , 11 , 12 , 18 Another important factor contributing to the success of this procedure is flexible fascia and less oblique inguinal canal, allowing easy traction on external ring and greater visibility of internal ring. 9 , 10 …”

“…Traditional teaching for inguinal herniotomy is to do MBH in children under the age of two years and FGH in older children. 2 , 3 , 9 - 11 …”

“…7 Initially it was thought that MBH in older children prevents effective ligation and leads to recurrence, yet studies indicate the inguinal canal length to be in between 4-23 mm to 40-65 mm maximum in children and by applying gentle traction on superficial ring, hernial sac can be ligated at the level of pre-peritoneal fat effectively as tissues are elastic. 9 - 12 A study conducted by Jadhav and co-authors, mentioned the recurrence rate of FGH as 6%. 13 In another study, the recurrence of both the techniques were 0%.…”

Complications of inguinal hernia repair in children: A tertiary hospital experience

“…I nguinal hernia is one of the most common conditions in children and is a frequent reason for surgical intervention 1 . Inguinal hernia has an incidence of 3.5 to 5.0% in full term infants while in preterm babies; complications following surgery for inguinal hernia repair (both emergency and elective) at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria, between January 2014 and December 2018.…”