Surgical treatment of inguinal herniae in children

Abstract

The aim of this paper was to assess if there is a standard technique for the repair of inguinal herniae in children and to establish if the inguinal canal should be routinely opened during this procedure in different age groups. A postal survey was conducted by sending questionnaires to 264 consultant surgeons who were surgical tutors or advisors to the Royal College of Surgeons of England. Information was sought using a multiple-choice tick-box questionnaire. The surgical techniques of surgeons working in specialist units were compared with those working in general units, and comparisons were also drawn between surgeons performing more operations than those doing only a few and also if the technique varied with the age of the patient. The response rate was 69%. Only 23% working in specialist units and 8% from general units performed more than 30 herniotomies per year. Overall, 15% of surgeons always performed the operation through the inguinal canal, 56% performed it superficial to the external ring, and 29% tended to do both. In children under the age of 2 years, most surgeons performed the operation superficial to the external ring, although a higher proportion of surgeons at specialist units opened the inguinal canal routinely. In the older age groups, the tendency to open the inguinal canal and/or divide the external ring was greater. However, surgeons at specialist paediatric units and those performing more than 30 herniotomies in a year were more likely to open the inguinal canal without dividing the external ring in all age groups. There was quite obviously no standard surgical technique for inguinal herniotomy in children in this survey, and there are only trends.

Laparoscopic inguinal hernia repair—a prospective personal series of 542 children

“…Surgical techniques are constantly refined because of new technology and will further reduce the recurrence rate. Even in open surgery, there is still no generally accepted uniform technique [15]. After laparoscopic repair, the structures at the internal ring appear bbunched up.Q After desufflation, however, the internal ring will collapse and loosen up.…”

Preperitoneal approach for herniotomy in infants: a 9-year review

“…In both the United Kingdom and North America opening the inguinal canal and dissecting the sac from the cord is widely practiced [17,18]. However, damage to the ilioinguinal nerve, vas deferens, testicular atrophy and testicular maldescent are recognised complications of this approach [15,19,20].…”

Incarcerated ovarian inguinal hernia in a 10-month-old girl

“…The incidence is highest during the first year of life, with more than one-third of cases occurring in infants aged less than six months. [1][2][3] Inguinal hernias tend to affect male infants more often than female infants, with documented ratios ranging between 3:1 and 10:1.…”