Surgical consideration of pediatric inguinal hernia / 中国实用外科杂志

Children's pelvic and abdominal wall muscles have not yet matured. The inguinal canal is shorter(can be less than 1 cm), and the ratio of thickness of abdominal wall to length of inguinal canal is almost 1:1. The distance between the internal ring and the external ring is so close that only requires a high level of ligation at internal ring, lacking of repairing basis. As the growth and development of pelvis, the length of the inguinal canal will also increase. Generally, when the length is more than 3 cm, there is the basic conditions of inguinal hernia repair, therefor under the age of 14 with groin hernia, the patient only need to receive a high ligation of the sac to restore the length and slope of the inguinal canal.Laparoscopic surgery is also in accordance with the basic principle. Mesh repair in primary inguinal hernia in childhood is suspected of overtreatment, at least is academical controversal.

Laparoscopic percutaneous extraperitoneal closure does not affect vas deferens orientation or testicular volume and perfusion / 中华男科学杂志

Objective@#To investigate the influence of single-port laparoscopic percutaneous extraperitoneal closure (LPEC) on the orientation of the vas deferens and the volume and perfusion of the testis in pediatric patients undergoing inguinal hernia repair.@*METHODS@#A total of 92 consecutively enrolled boys diagnosed with unilateral inguinal hernia underwent single-port LPEC between June 2013 and June 2014. The orientation of the vas deferens and the testicular volume and perfusion of the patients were ultrasonographically assessed preoperatively and at 1 and 6 months after surgery.@*RESULTS@#All the surgical procedures were performed successfully without conversion or serious perioperative complications. Ultrasonography showed no angulation or distortion of the vas deferens on the surgical side during a six-month follow-up period. Similarly, no obvious changes were observed in the testicular volume or perfusion.@*CONCLUSIONS@#Single-port LPEC is safe and effective in the treatment of pediatric inguinal hernia and does not affect the orientation of the vas deferens or testicular volume and perfusion.

Application of Improved Micro-laparoscopic High Ligation in Pediatric Inguinal Hernia / 昆明医科大学学报

Objective To compare the treatment effects between improved micro-laparoscopic hernia sac high ligation and traditional hernia sac high ligation.Methods Retrospective analysis was conducted.A total of 200 pediatric patients diagnosed with inguinal hernia in our hospital from 2013 to 2014,ranging in age from 8 months to 14 years,were enrolled and divided into observational group and control group (n=100) The two groups received improved-micro-laparoscopic hernia sac high ligation and traditional hernia sac high ligation respectively.We recorded intraoperative blood loss,operative incision length and operation time during the operation,and hospitalization time,pain time and total cost after the operation.Recurrence rate and complication were followed up for 6 months.Treatment effects were compared between these two groups.Results Smaller incision length,less blood loss and postoperative pain,shorter operative time and hospitalization time and lower recurrence rate were found in observational group and they were of statistical significance (P＜0.05).Conclusion Improved-micro-laparoscopic hernia sac high ligation for pediatric inguinal hernia shows better treatment effect,lower recurrence rate and better prognosis and it is an ideal approach.

Pediatric Inguinal Hernia Surgery 2,230 Cases Performed with Ketamine and Lidocaine

Ketamine is a safe and effective drug for pediatric anesthesia, sedation and analgesia. We hoped to identify that surgeons could operate a pediatric hernia with the ketamine anesthesia without general anesthesia. The study was a consecutive case series of 2230 inguinal hernia patients aged 1 months to 17 years in a Joo's day-surgical clinic during 11-year period. The patients had pediatric inguinal hernia surgery without general anesthesia under the day-surgery system. We retrospectively analyzed the medical record of patients who were registered with the Diagnosis Related Group (DRG) system. All patients received ketamine (5mg/kg) and atropine (0.01mg/kg) intramuscularly before surgery. After anesthesia, we injected 1~2% lidocaine (Less than 5ml) subcutaneously at the site of incision and started operation. The surgical method was the high ligation method of the hernia sac.) In total 2230 patients, male were 1756 and female were 474. 2076 patients were a unilateral inguinal hernia at the time of surgery and 154 were bilateral hernia patients. Less than three months, depending on the age of the patients was 391, and less than 12 months the patient was 592 people (26.5%). After surgery, there were no accidents or long term complications associated with ketamine anesthesia. We think the surgeon can safely do the pediatric inguinal hernia surgery using ketamine and lidocaine without anesthesiologist through 11 years of our surgical experiences.

One surgeon experiences in childhood inguinal hernias / 대한외과학회지

PURPOSE: In this manuscript we report one pediatric surgeon's experience in childhood inguinal hernia repair. METHODS: From 2005 to 2008, 402 children with inguinal hernias were operated on by one surgeon. A retrospective survey of their charts was carried out to evaluate the demographics and clinical aspects of these patients. RESULTS: The ages ranged from 20 days to 16 years with a male-to-female ratio of 2.5:1. 64.9% right, 27.1% left, and 7.9% bilateral hernias. Hydroceles were present in 6.2% assosiated hernias. Incarceration occurred in 8.7% of children. An opposite-side hernia developed in 5.7%. 5.3 percent of patients with a hernia repair on the right side later developed a hernia on the left side, and 8.2% of patients with a hernia repair on the left side later developed one on the right side. 4.5 percent of all male patients in this series and 8.6% of female patients developed an opposite-side hernia. While overall recurrence rate was 1.2%, our recurrence rate was 0.25%. There was a 0.24% wound infection rate, and 1 (0.24%) testicle was atrophic at follow-up. CONCLUSION: In this study, in the recurrence of childhood hernia, the general surgeon's intervention was the prominent cause. It is suggested by the study that inguinal hernias on the contralateral side becomes symptomatic within the first six months following initial operation.Therefor, close observation is needed in that time.

A Clinical Analysis of 200 Cases of Pediatric Inguinal Hernia

BACKGROUND: Inguinal hernia is one of the most common surgical diseases in pediatric patients. We reviewed pediatric inguinal hernia cases retrospectively to analyze the clinical characteristics. METHODS: We reviewed 200 herniorrhaphies in 194 patients who were under the age of 15 and who were operated on at Chungbuk National University Hospital from January 1992 to July 1997. RESULTS: 1) All of the cases were indirect inguinal hernias. Sliding hernias were noticed in 6 cases. High ligations were performed in all cases except 2 cases of Bassini operations. 2) Boys were affected 3.4 times more often than girls. 56.2% of the hernias occurred on the right side, 35.0% on the left side, and 8.8% bilaterally. Bilateral inguinal hernias occurred more often in girls (13.6%) than in boys (7.3%). 3) Hernias were noticed under the age of 1 year (47.9% of the cases). In most of those cases, operations were delayed. Especially, the operations were delayed more than 3 months for 82.1% of patients with hernias and under the age of 6 months. 4) On admission, most patients complained of inguinal or scrotal swelling and inguinal pain or discomfort. 5) Hospitalization occurred in 20.6% of the cases, 3 of which needed emergency operations. Hospitalization occurred in 47.5% of the cases under the age of 1 year; in those cases, hernias were noticed within the first 6 months, and in most of those cases, operations were delayed more than 3 months. 6) Postoperative complications occurred in 9 cases, i.e., 8 cases of scrotal swelling and 1 case of scrotal hematoma. There were no recurrent cases after operation (average follow-up of 33 months). 7) After unilateral inguinal hernia repairs, contralateral hernias developed in 10 patients including 4 patients who had had received their first hernia operations at other hospitals. The sex ratio was 9:1. Laterality of the first hernias were right in 5 cases and left in 5 cases. Contralateral hernias developed within an average of 4.8 months after the first operation; however, 6 cases developed within 6 months after the first operation. CONCLUSIONS: Education for early operation to prevent complications of hernias and careful evaluation of contralateral inguinal hernias in unilateral hernias are needed in the treatment of pediatric inguinal hernias.

Ultrasonographic Measurement of the Diameter of Internal Inguinal Ring and Prediction of Bilaterality in Pediatric Inguinal Hernia

BACKGROUND: It has been reported that bilateral pediatric inguinal hernias (PIH) are around 10% and that a late contralateral herniorrhapy is needed in up to 34% of ipsilateral operations. However, clinical prediction of the contralateral patent processus vaginalis (PPV) is difficult. The aims of this study were to measure the mean diameter of the internal inguinal ring (IIR) of the PIH at rest and during straining and to define the diagnostic criterion for positive contralateral PIH (or PPV) by using ultrasonography (USG). METHODS: The diameters of both ipsilateral and contralateral IIRs at rest and during straining were measured preoperatively by USG in 104 consecutive pediatric patients (75 male, 29 female; mean age of 3 years) who had undergone an ipsilateral herniorrhaphy with contralateral exploration from March 1997 to December 1997. Fifty-seven right inguinal hernias (RIH), 43 left inguinal hernias (LIH), and 4 bilateral inguinal hernias were enrolled. The contralateral PPV was defined as a sac greater than 3 mm in diameter and longer than 2 cm in length measured intraoperatively. Statistical analysis was performed by using the t-test and the chi-square test. RESULTS: Contralateral exploration showed positive PPV in 44% of RIH and 47% of LIH (p>0.05). In RIH, the mean diameter of right IIR (RIIR) was wider than that of left IIR (LIIR) (5.02+/-0.27 mm vs 2.94+/-0.12 mm at rest and 7.50+/-0.52 mm vs. 3.82+/-0.23 mm during straining, p<0.01), and the difference in diameters between straining and rest were also significant (2.38+/-0.37 mm in RIIR and 0.76+/-0.14 mm in LIIR, p<0.01). In LIH, the mean diameter of LIIR was wider than that of RIIR (4.59+/-0.27 mm vs. 3.13+/-0.19 mm at rest, 6.82+/-0.43 mm vs. 3.61+/-0.26 mm during straining, p<0.01). The diameter difference between straining and rest of LIIR and RIIR were also significant (2.17+/-0.28 mm in LIIR, 0.60+/-0.12 mm in RIIR, p<0.01). Cases of positive contralateral PPVs in RIH had significantly wider LIIRs than those of negative PPV (3.5+/-0.16 mm vs. 2.5+/-0.14 mm at rest and 4.70+/-0.32 mm vs. 2.97+/-0.20 mm during straining, p<0.01). The difference of diameter between strainingand rest of positive and negative PPVs were significant (1.16+/-0.25 mm and 0.38+/-0.09 mm, respectively, p<0.01). Cases of positive contralateral PPVs in LIH had wider RIIRs than those of negative PPV significantly (3.83+/-0.27 mm vs. 2.52+/-0.18 mm at rest and 4.58+/-0.38 mm vs. 2.68+/-0.19 mm during straining, p<0.01). The diameter difference between straining and rest of positive and negative PPVs was significant (0.93+/-0.21 mm and 0.3+/- 0.09 mm, respectively, p<0.05). CONCLUSION: In most negative PPVs, the diameter of the IIR did not exceed 3.0 mm. Therefore, contralateral IIR with diameters wider than 3.0 mm and diameters of difference more than 1.0 mm between straining and rest, as determined by using USG need to be explored.

Clinical Observations of Inguinal hernia in Pediatric Patients

This article consists of a clinical analysis of 221 cases of the Pediatric Inguinal Hernia treated in General Surgery of Pusan Adventist Hospital, from January 1990 to June 1996. The results were as follows ; 1) Patients with inguinal hernia were 37.5% of total operative patients in the division of pediatric surgery 2) Males predominated over females by the ratio of 5.5:1 3) Of 221 cases, 101(54%) were on the Rt side, 80(43.1%) on the Lt side and the remainder (6.4%) on both side in case of Male. 20(58.8%) were on the Rt side, 13(38.2%) on the Lt sid and the remainder (3.0%) on both side in case of Female. 4) The chief Complaints were inguinal protrusion in 131 cases(59.3%) and scrotal enlargement in 77 cases(34.9%) 5) Peak incidence age (32 Months) & Duration of history (20.2 Months) 6) Associated diseases were found in 10 cases(4.9%) and they were cryptorchidism (1.47%), hydroclele (0.98%), Umbilical hermia (0.49%), Heart anomaly (0.49%), cleft palate (0.49%), Teratoma (0.49%), and Jejunal atresia (0.49%). Family History was denied. 7) All were indirect hernia. 8) Incarcerated cases were 6(2.7%) and the ratio of male to female was 2:1, and the location of incarcerated hernia was Rt (66.6%), and Lt (33.3%) 9) There were 70 cases of strangulation. 10) Intraperitoneal organ in hernial sac was noted in 5 cases (2.26%), and they were ovary and fallopian tube in 3 cases (1.35%), small intestine in 1 case (0.45%), cecum and appendix in 1 case (0.45%). 11) 215 (97%) of all hernia were repaired only by highligation of sac and 6(3%) were inforced with Bassini's posterior wall repair. 12) Mean postoperative hospitalization were 5.2 days. 13) Postoperative complications occured in only 2 cases : hematoma and edema 1, wound infection 1.