Sac ligation in inguinal hernia repair: A meta-analysis of randomized controlled trials

Kao, Chun Yu; Li, Ching Li; Lin, Chao Chun; Su, Chih-Ming; Chen, Chia Che; Tam, Ka Wai

doi:10.1016/j.ijsu.2015.02.043

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…The mechanism of these 2 techniques are that, the lower edge of the distal sac was lifted and fixed to the posterior abdominal wall in the site lateral and cranial to the internal ring, which prevents the inflow of the exudation fluid generated in the preperitoneal space during and after operation into the distal hernia sac in the scrotum. 11 Several studies in open inguinal hernia surgery have reported increased postoperative pain after hernia sac ligation, 22,23 1 explanation is that the peritoneum is a highly innervated membrane, the ischemia and necrosis caused by ligature may augment postoperative pain. However, in the present study, the postoperative pain was not significant different between the sac transection and complete sac reduction groups, therefore, the present study indicates that during laparoscopic inguinal hernia repair, indirect hernia sac transection and ligation would not increase the postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies in open inguinal hernia surgery have reported increased postoperative pain after hernia sac ligation,22,23 1 explanation is that the peritoneum is a highly innervated membrane, the ischemia and necrosis caused by ligature may augment postoperative pain. However, in the present study, the postoperative pain was not significant different between the sac transection and complete sac reduction groups, therefore, the present study indicates that during laparoscopic inguinal hernia repair, indirect hernia sac transection and ligation would not increase the postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Management of Indirect Inguinal Hernia Sac in Laparoscopic Inguinal Hernia Repair: A Systemic Review of Literature

Bao²,

Shao

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Management of Indirect Inguinal Hernia Sac in Laparoscopic Inguinal Hernia Repair: A Systemic Review of Literature

Bao²,

Shao

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…7 Shulman A.G et al added over 6000 patients to their previous study and concluded that ligation is a needless step in adult hernioplasty in 1993. 10 18 We have already concluded in our previous study published in 2015 13 that non ligation of sac does not lead to any increased rate of recurrence and other complications in elective cases. We wanted to confirm if same is true for emergency Paediatric Hernia cases as well.…”

Section: Discussionmentioning

confidence: 83%

Is It Mandatory to Ligate Sac in Emergency Herniotomy in Pediatric Age Group? A Prospective Cohort

Haj

Asad

Qureshi

et al. 2022

J Ayub Med Coll Abbottabad

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Background: Herniotomy is standard treatment for inguinal hernia in children. Paediatric surgeons remain divided on whether ligation of sac is mandatory. In our study, we left the sac open to see early recurrence. Methods: This quasi=experimental study, done in emergency cases, was sequel to our previous study done in elective cases. It was carried out at surgical unit C of Ayub Hospital Complex, Abbottabad, from Jan 2016 to June 2020. Children from birth to 12 years of age were randomly divided into two groups. In group I (experimental), sacs were cut high up and left open during herniotomy while in group II (control), high ligation of hernia sac was done. Follow up was scheduled for day 10 and 1, 3 and 6 months. Patients were assessed for early recurrence and other complications. Results: A total of 151 emergency inguinal herniotomies were done including 147 males (97.4%) and 4 females (2.6%). 136 sacs (90.1%) were ligated with vicryl 3/0 or 4/0 while 15 sacs (9.9%) were left open. We did not find early recurrence, but found 1 case of scrotal hematoma (n=1/15) (6.7%) and 1 case of scrotal oedema (n=1/15) (6.7%) in the experimental group. In control group, complications were similar with 7 cases of hematoma (n=7/136) (5.1%) and 9 cases of scrotal oedema (n=9/136) (6.6%). Conclusion: Complications are comparable in herniotomy with or without ligation of sac but ligation adds an extra step. Herniotomy without sac ligation in children is safe and preferable in emergency setup.

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“…It is often congenital and arises from a patent processus vaginalis, a peritoneal channel that has failed to close and is also found in up to 90% of undescended testes (1)(2)(3). Although some surgeons suggested the nonligation of the processus vaginalis in the context of a indirect hernia and orchidopexy, their findings were based on limited evidence to be interpreted with suspicion (4,5). On the other hand, failure to ligate the sac high enough at the internal ring has been reported as a factor leading to recurrences in open hernia repair (1).…”

Section: Discussionmentioning

confidence: 99%

Dev İnguinal Herni Onarımı veya Orşiopeksi Sırasında Yırtılan Fıtık Kesesi İçin Basit ve Etkili Bir Teknik: İnsizyon

KARAKUŞ,

SUZEN,

ERTURK

2023

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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Tearing of hernial sac during giant inguinal hernia repair or orchiopexy presents a challenge to the pediatric surgeons, even in expert hands. We here describe a technique that is easy for performing high ligation in cases complicated with torn hernial sac. The steps of our incision technique is: Non-separated part was tightened with the help of forceps localized at the lateral aspects of teared sac. The incision to the sac was fashioned by scalpel No 15, while taking care to avoid injury to the underlying testicular vessels and vas deferens. Then, wound edges of the proximal hernia sac were moved forward by using fine tissue forceps and scalpel. The walls of proximal sac were totally grasped in one forceps and dissected gently from the remaining adhesions and cremasteric fibers up to the level of the internal ring. The mean age of the patients was 13.9±18.1 months (range 3 weeks-7 years). The diagnosis of the patients was inguinal hernia in 17 (63%) and undescended testis in 10 (37%). Seven (25,9%) of the patients had a large inguinal hernia sac. There were no intraoperative and postoperative complications. This is a safe and effective technique in patients complicated with torn hernial sac during herniotomy. It reduces the risk of further tearing of hernial sac. Short duration is another advantage. This technique can also be performed with using surgical loupe or microscope to care not to damage the vas and vessels.

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Sac ligation in inguinal hernia repair: A meta-analysis of randomized controlled trials

Abstract: Hernia sac ligation was associated with higher postoperative pain, and did not show any benefit over sac nonligation regarding the incidence of recurrence and postoperative complications in patients undergoing open tension-free mesh repair or laparoscopic procedures.

Cited by 10 publications

References 15 publications

The Management of Indirect Inguinal Hernia Sac in Laparoscopic Inguinal Hernia Repair: A Systemic Review of Literature

The Management of Indirect Inguinal Hernia Sac in Laparoscopic Inguinal Hernia Repair: A Systemic Review of Literature

Is It Mandatory to Ligate Sac in Emergency Herniotomy in Pediatric Age Group? A Prospective Cohort

Dev İnguinal Herni Onarımı veya Orşiopeksi Sırasında Yırtılan Fıtık Kesesi İçin Basit ve Etkili Bir Teknik: İnsizyon

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