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【Objective】 To evaluate the feasibility and safety of laparoscopic partial excision of the cyst wall combined with internal inguinal ring repair in the treatment of pediatric abdominoscrotal hydrocele (ASH). 【Methods】 Clinical data of 12 ASH children treated during Mar.2017 to May 2020 were retrospectively analyzed, including clinical manifestations, preoperative diagnosis, intraoperative findings, and postoperative results. 【Results】 A preoperative diagnosis of ASH was made in 9 cases. In the other 3 cases, ASH was detected during laparoscopic repair of the hydrocele. The opening of the internal inguinal ring was wide and cavernous, and patent processus vaginalis (PPV)was detectedin all cases. Contralateral pathologies were detected in 5 cases, including hydrocele in 4 and inguinal hernia in 1. All patients received laparoscopic partial excision of the cyst wall combined with internal inguinal ring repair. During the follow-up of 6-37 months, no recurrence of ASH or ipsilateral hernias occurred, and no testicular atrophy was observed. 【Conclusion】 Laparoscopic partial excision of the cyst wall combined with internal inguinal ring repair is effective, safe and feasible in the treatment of the pediatric ASH.
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ABSTRACT Objective: Laparoscopy has been accepted as the best diagnostic tool and suggested as the treatment of choice for non-palpable testes cases. However, its use in unilateral non-palpable testis cases has been previously debated. Methods: The clinical records of the non-palpable testis cases that were managed with laparoscopy between January 2011 and December 2013 were retrospectively reviewed. Results: Laparoscopy was performed in 29 non-palpable testis cases. The cases were divided into three groups according to the laparoscopic findings. Orchiopexy was performed in cases with viable testes, and the internal inguinal ring was left open in these cases. Conclusion: Laparoscopy provided definitive diagnosis and was helpful in the treatment of unilateral, non-palpable testis cases. Leaving the internal inguinal ring open did not result in subsequent indirect inguinal hernia in our cases.
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Uma mula hígida, de cinco anos de idade, foi atendida portando um aumento de volume na região abdominal lateral direita, estendendo-se da região inguinal até 25cm cranial à prega pré-crural, de 60 dias de evolução, após trauma com um touro. O volume era redutível e sem dor à palpação, com presença de intestino grosso envolvido por área circular hiperecogênica na imagem ultrasonográfica. O diagnóstico foi hérnia inguinal, e a paciente foi submetida à anestesia geral inalatória para abordagem cirúrgica pela região inguinal, onde se visualizou o ceco emergindo pelo anel inguinal externo, cujo diâmetro era de aproximadamente 10cm. O ceco apresentava coloração e conteúdo normais e parte do corpo e o ápice projetavam-se cranialmente para uma bolsa de tecido subcutâneo, que foi aberta para facilitar o reposicionamento do órgão ao abdômen, bem como para ampliar o anel inguinal externo. A paciente teve alta 18 dias após o internamento. Com base neste relato, é possível concluir que a hérnia inguinal indireta não encarcerada pode se desenvolver em fêmeas equídeas após trauma. De acordo com a literatura consultada, o presente estudo é a primeira descrição desse tipo de hérnia em uma fêmea equídea e a primeira envolvendo o ceco.(AU)
A five-year-old healthy mule was referred with enlarged volume in the ventral right side of the abdomen, with 25cm in length from the inguinal region to precrural fold, developed 60 days previously due to a traumatic confrontation with a bull. The mass had no pain and was reductible on palpation and the ultrasonographic examination revealed large intestine surrounded by a hyperecoic ring. Based on these findings, the diagnosis was non incarcerated inguinal hernia. Under general anesthesia, the patient was submitted to surgery by direct approach on the inguinal region, when the cecum was seen emerging from a 10cm overture of the external inguinal ring and projecting to a subcutaneous fold cranially to the ring. This fold and the external inguinal ring were opened to facilitate the reposition of the cecum back to the abdomen. Eighteen days after the surgery the patient was discharged with a satisfactory recovery. Based on this report, it is possible to conclude that females can develop indirect non incarcerated inguinal hernias with the involvement of the cecum with good prognosis. Based on the consulted literature, this is the first report of this type of hernia in a female equine.(AU)
Subject(s)
Animals , Female , Cecum/surgery , Equidae/surgery , Hernia, Inguinal/surgery , Hernia, Inguinal/veterinaryABSTRACT
Complete duplication of testicular veins is a rare phenomenon. However, a few cases of duplication of gonadal veins have been reported. Here, I report a case of unusual formation and termination of the right testicular vein in an adult male cadaver. Five veins arose from the pampinniform plexus and entered the abdomen through the deep inguinal ring. The most medial among the five was large (3 mm in diameter) and it continued as a testicular vein and opened into the right edge of the inferior vena cava, 1 cm above the union of the common iliac veins. The other four veins were about 1 mm in diameter and they united to form two veins in front of the lower part of the right psoas and iliacus muscles (about 2 cm above the deep inguinal ring) and the two veins united to form upper testicular vein, 4 cm above the deep inguinal ring. This testicular vein was 3 mm in diameter and it opened into the inferior vena cava, 4 cm above the union of common iliac veins. Having five veins at deep inguinal ring might increase the chances of varicocele and decrease the chances of indirect inguinal hernia.
La duplicación completa de las venas testiculares es un fenómeno raro. Sin embargo, se han reportado algunos casos de duplicación de venas gonadales. En el presente trabajo se informa un caso de formación y terminación inusual de la vena testicular derecha en un cadáver de un hombre adulto. Cinco venas surgieron del plexo pampiniforme y penetraron en el abdomen a través del anillo inguinal profundo. El más medial entre los cinco fue de gran tamaño (3 mm de diámetro) y continuó como una vena testicular y se abrió hacia el margen derecho de la vena cava inferior, 1 cm por encima de la unión de las venas ilíacas comunes. Las cuatro venas restantes eran de 1 mm de diámetro aproximadamente, y se unieron para formar dos venas frente a la parte inferior de los músculos psoas e ilíaco derechos (aproximadamente 2 cm por encima del anillo inguinal profundo). Se unieron dos venas para formar la vena testicular superior, la cual medía 3 mm de diámetro y se abría hacia la vena cava inferior, 4 cm por encima de la unión de las venas ilíacas comunes. Cinco venas en el anillo inguinal profundo podrían aumentar las posibilidades de varicocele y disminuir las posibilidades de una hernia inguinal indirecta.
Subject(s)
Humans , Male , Middle Aged , Veins/abnormalities , Inguinal Canal/blood supply , Testis/blood supply , Varicocele/etiology , Vena Cava, Inferior/abnormalities , Gonads/blood supply , Hernia, Inguinal/etiologyABSTRACT
Background: The inguinal canal is an oblique intermuscular passage lying above the medial half of the inguinalligament. Its size and form vary with age and sex, although it is present in both sexes, it is most well developedin male. The inguinal canal in both sexes has been studied by many workers both in India and in other countries.It is observed that the inguinal hernia and recurrence of hernia after surgery is very common in the kosi regionof Bihar. This observational study may help the surgeons during the operation of inguinal hernia.Materials and Methods: Present study conducted at the department of Anatomy, Katihar medical college andhospital Katihar and Lord Buddha Kosi Medical College, Saharsa during the period of 2010 to 2016. The cadaverprovided for dissection to the student of first professional MBBS, are selected for the study. Cadavers withinjured groin region are not taken for the study. Measurements were done by stainless steel scale and spreadingcalliper during dissection of groin region.Results: Anatomy of inguinal canal, superficial inguinal ring, the deep inguinal ring and the related structureswas studied in details in 50 cadavers in the dissection hall at the time of dissection. During this study I havefound that the average length of inguinal canal in the male was 38.35 mm. The longest diameter of deep inguinalring is 13 mm and smallest diameter is 9 mm. The average measurement of superficial inguinal ring was 12mmalong the base and 24mm from apex to base.Conclusion: At the end of the study I have found a little variation from the established facts related to diameter ofsuperficial inguinal ring, position of deep inguinal ring and direction of fibres of external oblique aponeurosis.
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Objective To explore the treatment of children with hernia,and the advantage of transabdominal extraperitoneal hernia sac exclusion was analyzed.Methods A total of 102 patients in our hospital from January 2005 to January 2015 were randomly divided into 2 groups,55 cases who treated by the surgery of transabdominal extraperitoneal hernia sac exclusion were treatment group,47 cases who treated by the surgery of high ligation of the hernia sac throug the inguinal incision were control group.The operative time,length of hospital stay, length of incision,postoperative pain and hospitalization costs between two groups were compared.Results The effect of the treatment group was superior to the control group on operative time,length of incision and postoperative pain,the difference was significant(P <0.05).Con-clusion There are some advantages of more simplified operation,shorter time of the surgery,less complication,lower recurrence rate and more reliable curative effect in the treatment of transabdominal extraperitoneal hernia sac exclusion for children with hernia,which is worthy of clinical promotion.
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The aim of this study was to explore the clinical efficacy of a novel retrograde puncture approach to establish a preperitoneal space for laparoscopic direct inguinal hernia repair with inguinal ring suturing. Forty-two patients who underwent laparoscopic inguinal hernia repair with retrograde puncture for preperitoneal space establishment as well as inguinal ring suturing between August 2013 and March 2014 at our hospital were enrolled. Preperitoneal space was successfully established in all patients, with a mean establishment time of 6 min. Laparoscopic repairs were successful in all patients, with a mean surgical time of 26±15.1 min. Mean postoperative hospitalization duration was 3.0±0.7 days. Two patients suffered from postoperative local hematomas, which were relieved after puncturing and drainage. Four patients had short-term local pain. There were no cases of chronic pain. Patients were followed up for 6 months to 1 year, and no recurrence was observed. Our results demonstrate that preperitoneal space established by the retrograde puncture technique can be successfully used in adult laparoscopic hernioplasty to avoid intraoperative mesh fixation, and thus reduce medical costs.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Inguinal Canal/surgery , Laparoscopy/methods , Punctures/methods , Suture Techniques , Anatomic Landmarks , Peritoneal Cavity/surgery , Reproducibility of Results , Treatment OutcomeABSTRACT
During the routine dissection of abdomen, two adult male cadavers, aged 55 & 67years, presented with unilateral and the bilateral undescended testes respectively. One of them presented with unilateral and the other with bilateral undescended testes. In both cases the testes were found at the superficial inguinal ring. The histological examinations indicated normal testicular tissue. Undescended testis is the inability of the testis to reach the scrotum. In living, it has to be differentiated from testicular agenesis, ectopic testis and retractile testis. The genetic sex of the male is determined at the time of fertilization but the phenotypical sex starts as early as 4th month of intrauterine life and completed along with the descent just before birth. The embryological basis and clinical significance has been explained.
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Background: This study has the purpose to investigate the microscopic basic histological structure of the internal inguinal ring in patients operated on for primary indirect inguinal hernia. Patients and Methods: A sample of 72 consecutive male patients older than 15 years-of-age with unilateral inguinal hernia submitted to elective surgery was studied. The primary outcome measure was the histological findings of the internal inguinal ring. All samples were processed only by histochemical techniques. Patients were divided in 3 groups according to age. Group I: patients between 15 and 40 years-of-age. Group II: patients between 41 and 70 years-of-age. Group III: patients older than 71 years. Results: All samples from the internal inguinal ring were constituted by fibrous fascial tissue with elastic fibers which were thicker in younger patients and thinner in older patients. Adipose tissue between elastic fibers was absent in younger patients and was abundant in older patients. Vascular sclerosis was minimal in Group I, moderate in Group II, and important in Group III. Acute or chronic inflammatory cells were absent in all patients. Conclusions: The histological characteristics of the internal inguinal ring in patients with indirect inguinal hernia consist on reduced density and thickness of elastic fibers and increased adipose tissue between elastic fibers. Vascular sclerosis was more severe as the age of the patients increased. These histological changes were related to normal aging.
Introducción: El presente estudio tiene como objetivo investigar la estructura histológica básica del anillo inguinal interno en pacientes operados por hernia inguinal indirecta primaria. Pacientes y Métodos: Se estudió una muestra de 72 pacientes consecutivos mayores de 15 años de edad con hernia inguinal indirecta unilateral sometidos a cirugía electiva. El objetivo principal fue la histología básica del anillo inguinal interno. Las muestras fueron procesadas con técnicas histoquímicas. Los pacientes se dividieron en 3 grupos de acuerdo a la edad. Grupo I: pacientes entre 15 y 40 años de edad. Grupo II: pacientes entre 41 y 70 años. Grupo III: pacientes mayores de 71 años de edad. Resultados: Todas las muestras histológicas del anillo inguinal estuvieron constituidas por tejido fascial fibroso con fibras elásticas gruesas en pacientes jóvenes y delgadas en pacientes mayores. La esclerosis vascular fue mínima en el grupo I, moderada en el grupo II e importante en el grupo III. No se encontraron células inflamatorias agudas o crónicas. Conclusiones: Las características histológicas básicas del anillo inguinal interno consisten en fibras elásticas que disminuyen su densidad y se adelgazan con la edad y en un aumento simultáneo del tejido adiposo entre estas fibras. La esclerosis vascular se presenta y es más severa en la medida que la edad de los pacientes aumenta. Estos cambios histológicos se relacionan al envejecimiento normal.
Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Inguinal Canal/surgery , Inguinal Canal/pathology , Hernia, Inguinal/surgery , Hernia, Inguinal/pathology , Age Factors , Aging , Elective Surgical Procedures , Prospective StudiesABSTRACT
Se propone un protocolo de manejo para la patología herniaria en el Servicio de Cirugía General del Hospital Dr. Teodoro Maldonado Carbo de Guayaquil, cuyo propósito es unificar criterios para el manejo de esta patología tan frecuente en nuestro medio; siendo el objetivo principal disminuir las recurrencias, que fluctúan entre 4 y 6% según las estadísticas mundiales; independientemente de las variables atribuibles al equipo quirúrgico y evaluación exacta de cada caso.Como conclusiones podemos mencionar que la causa principal de recidiva es la tensión en la línea de sutura y que la técnica de Shouldice es la apropiada cuando existe defecto de la pared posterior. Este artículo resume una propuesta para el manejo de esta patología muy frecuente como resultado de la experiencia en este servicio.
We intend to propose a protocol for handling a hernial pathology in the Service of General Surgery of the Hospital of the I.E.S.S of Guayaquil. Our purpose is to unify criteria for the handling of this pathology that is very frequent in our society. Our main objective is to lower recurrences that are between 4 and 6% according to world statistics independent from variables such as surgery equipment and the evaluation of each case.As a conclusion the main cause of recurrence is the suture line tension. We also want to conclude that the Shouldice technique should be used when there is a defect on the posterior wall. This article summarizes a proposal of the handling of this pathology that is very frequent at our service.