Pediatric inguinal hernias, are they all the same? A proposed pediatric hernia classification and tailored treatment

Shehata, Sameh; Shehata, Sherif; Wella, Herman L; Abouheba, Mohamed; Elrouby, Ahmed

doi:10.1007/s10029-018-1816-y

Cited by 11 publications

(14 citation statements)

References 13 publications

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“…Also, in the recent study by Shehata et al [24] they reported that no recurrences had been detected in the follow-up. Also, Shehata et al [25] proposed classi cation for pediatric inguinal hernia according to size of internal ring. The average internal inguinal ring diameter was 7.7 mm ±1.5 SD (range of 5-10 mm), 16.7 mm±3.6 SD (ranging from 12 to 23 mm), and 22.6 mm ±4.6 SD (ranging between 16 and 33 mm) for Nyhus types PNI, PNII, and PNIII hernias, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[27] However, with better understanding, ner instruments, increased experience, and proper technique selection, the reported recurrence rates for laparoscopic hernia correction of (0.3% to 1.2%) were approached or became even lower than that of open repair. [25][26][27] There are many factors linked to hernia recurrence in laparoscopy. For example, incomplete separation or leaving an intact peritoneal gap above the vas and vessels in boys to avoid their injury, loose knot, use of absorbable suture in purse-string suturing without separation techniques, and large defects without narrowing the IIR, are very important causes for recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Needlescopic suturless repair of congenital inguinal hernia: A randomized controlled study

Shalaby

Abdelmaboud

Daboos

et al. 2023

Preprint

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Background: Many techniques have been published in the literature about laparoscopic treatment of congenital inguinal hernia [CIH]. Division of the sac, with suturing the peritoneal defect has been advocated by many authors. Others stated that peritoneal disconnection alone is enough. This study aimed to compare the results of needlescopic disconnection of CIH sac with or without peritoneal defect suturing as regards feasibility, operative details, recurrence rate, and postoperative complications. Patients and Methods: This study has been conducted prospectively on children operated upon by needlescopic separation of hernia sac at its neck with or without peritoneal defect suturing over the Internal Inguinal Ring [IIR] in the period from January 2020 to December 2022. Results: A total of 230 patients with 260 hernial defects were corrected by needlescopic disconnection with either suturing or without suturing of the defect. They comprised of 141 (61.3%) males, and 89 (38.7%) females. Their ages ranged from 0.5 to 12 years (mean=5.14 ± 2.79). Patients were distributed into group A (N=116 patients) and group B (N=114 patients). In sac separation and closure of the defect group A, the mean operative time was 27.98 ± 2.89 [Rang = from 20 to 30 minutes] for unilateral cases and 37.29 ± 4.68 [Range = from 25 to 40 minutes] for bilateral one, whereas in group B, the mean operative time was 20.37 ± 2.37 [Range=from 15 to 25 minutes] for one-sided and 23.38 ± 2.22 [Range =from 20 to 25 minutes] in two-sided cases. Conclusion: Needlescopic separation of hernia sac with suturing of peritoneal defect and disconnection without suturing for pediatric inguinal hernia repair, are feasible, safe, and less invasive with no recurrence and outstanding cosmetic results. However, non- suturing of peritoneal defect gives significantly shorter operative time than suturing of peritoneal defect

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Needlescopic suturless repair of congenital inguinal hernia: A randomized controlled study

Shalaby

Abdelmaboud

Daboos

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…There is no consensus definition of a wide ring, and our definition is based on experience. A recent article by Shehata et al 14 proposed pediatric Nyhus (PN) classification system for a tailored treatment of pediatric inguinal hernias. Along with herniotomy, the authors recommended narrowing of deep ring for PN type II and IPT repair for PN type III hernias.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic iliopubic tract repair for pediatric inguinal hernia has very low recurrence: an Indian experience

Nayak

Parthasarathi

et al. 2020

World Jnl Ped Surgery

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BackgroundThe aim of this study is to document results of laparoscopic iliopubic tract (IPT) repair for inguinal hernia in the pediatric age group.MethodsHospital records of 190 children who underwent IPT repair between January 2015 and January 2020 were analyzed retrospectively for demographic details, variations between clinical, radiological and laparoscopic diagnosis, associated pathologies, operative time, hospital stay, postoperative complications and follow-up. The internal ring was narrowed by approximating IPT to conjoint tendon using 3-0 polypropylene continuous or interrupted suture.ResultsIn total, 238 IPT repairs were done under general anesthesia in 190 children aged between 1 and 17 years. 7.9% of children had phimosis, and three children had hydrocele. Three patients had undescended testis and another three IPT repairs were done in cases who presented with appendicitis. Contralateral patent processus vaginalis (CPPV) was detected at the time of laparoscopy in 18.3% of cases. Thus far, 166 children had been followed, and no recurrence was observed in any of these 96 of whom have completed more than 3 years after their surgery. However, two patients developed hernia on the contralateral side.ConclusionsLaparoscopy is beneficial to pick up CPPV. Laparoscopic IPT repair for pediatric inguinal hernia is reproducible and safe with the least recurrence reported thus far. However, further follow-up is needed. Moreover, development of contralateral hernia needs to be investigated.

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“…(4) En ocasiones, sobre todo cuando se trata de hernias pequeñas, no se hace evidente al examen físico la hernia que refieren los familiares; en tal caso, se le indica al paciente que tosa, puje, se ponga en cuclillas o salte, esto hará que aumente la presión intraabdominal y que salga el contenido herniado. (5,6) AFECCIONES…”

Section: Manifestaciones Clínicasunclassified

Hernia inguinal en la infancia

Medina¹,

Ramos²,

Palma³

et al. 2023

Afecciones Clínico-Quirúrgicas Frecuentes en La Infancia

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hidroaéreos y, en ausencia de complicaciones, se puede reducir de forma manual con facilidad a la cavidad abdominal.El hecho de que sea la hernia inguinal la cirugía más frecuente que enfrenta el cirujano pediátrico durante su práctica habitual hace notar la importancia de conocer el manejo adecuado de esta afección para garantizar así una evolución favorable, sin complicaciones añadidas. Palabras clave: síndrome herniario, conducto peritoneo-vaginal, cirugía electiva, pediatría AbstractInguinal hernia in the pediatric age group is the reason for the greatest number of programmed and elective surgeries. This health problem affects 1-7% of the pediatric population; it predominates in males and can be unilateral or bilateral, although it is more frequent on the right side. It can be diagnosed at birth or later, at any age.Also known as inguino-scrotal hernia, it is congenital in infancy: when the peritoneo-vaginal duct -the structure that connects the abdomen with the inguinal region and which normally should close at birth-does not close properly, the abdominal viscera and structures pass into the inguinal or scrotal region, thus forming the hernia. It is characterized by a non-painful increase in volume in this region, which increases with coughing, physical exertion and crying; it is less evident and even disappears when the patient is lying down.On physical examination of the inguinal or inguinoscrotal region, a rounded protrusion with a smooth, non-painful surface, which is not radiolucent in the presence of light, is evident. When the hernia reaches a large size, it is possible to auscultate hydroaerial sounds and, in the absence of complications, it can be easily reduced manually into the abdominal cavity through the deep inguinal ring.The fact that inguinal hernia is the most frequent surgery encountered by the pediatric surgeon during his routine practice highlights the importance of knowing the proper management of this condition to ensure a favorable evolution, without added complications.

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Pediatric inguinal hernias, are they all the same? A proposed pediatric hernia classification and tailored treatment

Cited by 11 publications

References 13 publications

Needlescopic suturless repair of congenital inguinal hernia: A randomized controlled study

Needlescopic suturless repair of congenital inguinal hernia: A randomized controlled study

Laparoscopic iliopubic tract repair for pediatric inguinal hernia has very low recurrence: an Indian experience

Hernia inguinal en la infancia

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