ABSTRACT
【Objective】 To explore the rational management of contralateral patent processus vaginalis (CPPV) in laparoscopic high ligation of processus vaginalis. 【Methods】 A total of 300 children with unilateral oblique inguinal hernia/hydrocele who received laparoscopic high ligation of processus vaginalis in Baoding Children’s Hospital during Jun.2018 and Jun.2022 were selected and divided into two groups by random number table method, with 150 in either group. In the control group, 53 cases of CPPV were found intraoperatively, which were treated simultaneously. In the study group, 58 cases of CPPV were detected, among which 11 met the indications of high ligation and received simultaneous surgical treatment. The incidence of recurrence was compared between the two groups. 【Results】 After 1 year of follow-up, the recurrence rate was 8.62% in the study group and 1.88% in the control group (P>0.05). The detection rate of CPPV was 23.02% in children with unilateral inguinal hernia, significantly lower than that in children with unilateral hydrocele (49.07%, P<0.001). The detection rate of CPPV was 42.71% in children with left patent processus vaginalis and 32.95% in children with right patent processus vaginalis (P=0.19). The detection rate of CPPV was 62.93% in the age group of 1-2 years, significantly higher than that in other age groups (P<0.001). 【Conclusion】 The incidence of CPPV conversion into oblique inguinal hernia or hydrocele is low. Only children who meet the indications can be treated at the same time during surgery.
ABSTRACT
Las hernias inguinales son las anomalías más comunes en pediatría que requieren de tratamiento quirúrgico. El 70% desarrolla una hernia inguinal unilateral y el 30% restante desarrolla hernia inguinal contralateral. La finalidad de llevar a cabo una exploración contralateral es disminuir el riesgo de recurrencia de hernias metacrónicas en pacientes de riesgo que tienen persistencia del processus vaginalis, así como evitar el daño a estructuras subyacentes por llevar a cabo una exploración abierta1,2. El objetivo fue determinar la prevalencia de hernias inguinales contralaterales en niños y niñas menores de 5 años con factores de riesgo, identificadas a través de peritoneoscopía del 1 de marzo de 2015 al 31 de marzo del 2018 en el Hospital Roosevelt. El diseño de este estudio fue descriptivo y transversal. Se realizó en el departamento de Cirugía Pediátrica del Hospital Roosevelt en la ciudad de Guatemala. Los materiales y métodos empleados consistieron en un estudio realizado a través de la revisión de 128 expedientes de menores de 5 años del Departamento de Cirugía Pediátrica del Hospital Roosevelt que hayan presentado una hernia inguinal entre el período indicado y a quiénes se les practicó peritoneoscopía. Como resultado se comprobó que la prevalencia de hernia inguinal contralateral diagnosticada por peritoneoscopía fue del 59% IC(44,72), 26 casos, en cuyos casos se efectuó cirugía correctiva bilateral, sin recurrencia. Esto permitió concluir que la prevalencia de hernias inguinales se da con mayor frecuencia en niños y niñas menores. (AU)
Inguinal hernias are the most common anomalies in pediatrics that require surgical treatment. 70% develop a unilateral inguinal hernia and the remaining 30% develop a contralateral metachronous inguinal hernia. The purpose of performing a contralateral examination is to decrease the risk of recurrence of metachronoushernias in risk patients who have persisten tprocessus vaginalis, as well as to avoid damage to underlying structures by conducting an open exploration1,2. The objective was to determine the prevalence of contralateral inguinal hernias in boys and girls under 5 years of age with risk factors, identified through peritoneoscopy from March 1, 2015 to March 31, 2018 at Roosevelt Hospital. The design of this study was descriptive and transversal. It was performed in the Pediatric Surgery department of the Roosevelt Hospital in Guatemala City. The materials and methods used consisted of a study conducted through the review of 128 records of children under 5 years of the Department of Pediatric Surgery at Roosevelt Hospital who presented an inguinal between the indicated period and who underwent peritoneoscopy. As a result, it was found that the prevalence of contralateral inguinal hernia diagnosed by peritoneoscopy was 59% IC(44,72) 26 cases, in which cases bilateral corrective surgery was performed, without recurrence. This allowed us to conclude that the prevalence of inguinal hernias occurs more frequently in boys and girl. (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Hernia, Inguinal/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Laparoscopy , Sex Distribution , Hernia, Inguinal/diagnosisABSTRACT
Objective@#To determine the feasibility and short-term effect of single scrotal-incision orchidopexy (SSIO) without ligation of the processus vaginalis (PV) in the treatment of palpable undescended testis (PUDT).@*METHODS@#This retrospective study included 109 cases of PUDT (125 sides) and 15 cases of impalpable undescended testis (IUDT). The former underwent SSIO without PV ligation (group A, n = 53) or standard inguinal orchidopexy with PV ligation (group B, n = 56) while the latter received laparoscopic exploration (group C). We analyzed the success rate of SSIO in the management of PUDT, postoperative complications, and incidence rates of hernia and hydrocele, and compared the relevant parameters between groups A and B.@*RESULTS@#The median age of the PUDT patients was 1.4 (0.6－11.0) years. Group A included 24 cases of left PUDT (2 with hydrocele), 20 cases of right PUDT (1 with hydrocele), and 9 cases of bilateral PUDT, the success rate of which was 95.1%. Group B consisted of 27 cases of left PUDT, 22 cases of right PUDT (3 with hernias), and 7 cases of bilateral PUDT. The rate of PV patency in the PUDT patients was 80.8% (101/125). Laparoscopic exploration of the 15 IUDT patients revealed 2 cases of congenital testis absence, 6 cases of testis dysplasia, all treated by surgical removal, 3 cases of staying around the inner ring, descended by inguinal orchidopexy, and the other 4 treated by laparoscopic surgery. The incisions healed well in all cases, with no testicular atrophy, inguinal hernia or hydrocele.@*CONCLUSIONS@#Single scrotal-incision orchidopexy without PV ligation is a safe and feasible procedure for the treatment of palpable undescended testis, which avoids the risk of inguinal hernia or hydrocele.
Subject(s)
Child , Child, Preschool , Humans , Infant , Male , Cryptorchidism , General Surgery , Feasibility Studies , Gonadal Dysgenesis, 46,XY , Diagnosis , Hernia, Inguinal , Laparoscopy , Ligation , Orchiopexy , Methods , Postoperative Complications , Retrospective Studies , Scrotum , General Surgery , Surgical Wound , Testicular Diseases , Diagnosis , Testicular Hydrocele , Testis , Congenital AbnormalitiesABSTRACT
The area of inguinal canal and scrotum is complex and concealment where many clinical problems especially congenital abnormalities in infant occur.As the reasons of embryonic development and anatomy,most of the clinical problems have close inner link and external relationship.Evaluation and management of the infant with abnormalities in this area involves in structural restoration,prevention and treatment of severe emergencies,or in fertility and testicular tumorigenesis after puberty.As the structure and the long-term function and influence of this area,the studies on here are still focused and the knowledge always update.
ABSTRACT
The area of inguinal canal and scrotum is complex and concealment where many clinical problems especially congenital abnormalities in infant occur.As the reasons of embryonic development and anatomy,most of the clinical problems have close inner link and external relationship.Evaluation and management of the infant with abnormalities in this area involves in structural restoration,prevention and treatment of severe emergencies,or in fertility and testicular tumorigenesis after puberty.As the structure and the long-term function and influence of this area,the studies on here are still focused and the knowledge always update.
ABSTRACT
Inguinal hernia repair is one of the most frequently performed surgical procedures in pediatric patients. An inguinal hernia does not resolve spontaneously and must be repaired because of high risk of complications. A retrospective analysis was performed on the hospital records including operative notes of admitted pediatric patients, aged up to 12 years, who underwent inguinal herniotomy. On observation, male affect more than female , right side inguinal hernia more common than left, due to let decent of testis on right side. Early detection and repair of inguinal hernia in pediatric is essential to decrease the potential morbidity and operative complications rate. This needs an increase in popular and pediatric awareness.
ABSTRACT
A knowledge of the embryology and descent of the testes is essential for all clinicians. Congenital hydrocoele, though an embryologic anomaly can present in adulthood. A abdomino scrotal hydrocole must be considered when a mass in the lower abdomen co exists with a scrotal hydrocoele.
El conocimiento de la embriología y el descenso de los testículos es esencial para todos los clínicos. El hidrocele congénito, aunque es una anomalía embriológica se puede presentar en la edad adulta. Un hidrocele abdomino-escrotal debe ser considerado cuando una masa en la parte inferior del abdomen co existe con un hidrocele testicular.
Subject(s)
Humans , Male , Adult , Testicular Hydrocele/diagnosis , Testicular Hydrocele , Abdomen/abnormalities , Abdomen , Scrotum/abnormalitiesABSTRACT
It is known that pediatric inguinal hernia is caused by the incomplete closure of processus vaginalis (PV). In the case of unilateral hernia, possibile contralateral patent PV should be considered because of its delayed appearance as well as its risk of incarceration. Direct visualization of patent PV could be done by contralateral exploration or by indirect exploration through the ipsilateral opening site of the affected hernia assisted with laparoscope. A patient group (321 persons) to whom laparoscopy was not performed from March 2000 to March 2003 was analyzed and compared with a patient group (280 persons) to whom laparoscopy was performed from April 2003 to September 2005. With all 601 patients, the sex ratio (male/female) of patients was 3.8:1. The side distribution was 57.7% in the right, 32.1% in the left and 10.1% in bilateral. There was no difference of sex and side distribution between before and after laparosopy adoption. We did not find an age correlation in natural closure of the residual PV of the peritoneum. Contralateral hernia developed in 14 persons (2.5%) after the operation of unilateral inguinal hernia before laparoscope adoption. But no contralateral hernia developed after April 2003 with laparoscopy. We think that if we use laparoscopy, being a safe and accurate method, to check whether the contralateral residual PV is opened or closed, possible future contralateral operation can be avoided.
Subject(s)
Humans , Hernia , Hernia, Inguinal , Laparoscopes , Laparoscopy , Peritoneum , Sex RatioABSTRACT
PURPOSE: Laparoscopy through the open ipsilateral hernial sac to evaluate the contralateral side in boys with unilateral inguinal hernia has been criticized because of some risk and cost. Laparoscopic evaluation of the contralateral side was modified to avoid abdominal trocar insertion by using the open ipsilateral hernia sac for instrumentation. This study was performed to determine the usability, safety, and effectiveness of this technique. MATERIALS AND METHODS: Forty-two boys with unilateral inguinal hernia and hydrocele were evaluated using open hernial sac for diagnostic laparoscopy of the contralateral side at the time of inguinal herniorrhaphy. RESULTS: The mean age was 3.8 years. The presenting hernia was right-sided in 29 (69.0%) cases and left-sided in 13 (31.0%) cases. Based on the result of diagnostic laparoscopy 32 (76.2%) cases were negative on the contralateral side, and 10 (23.8%) were positive. After the contralateral exploration of the positive groups, 9 (90.0%) showed contralateral patent processus vaginalis. After undergone the high ligation of the patent processus vaginalis at the internal inguinal ring. CONCLUSIONS: Laparoscopic evaluation of the contralateral side via the open ipsilateral hernial sac is feasible, quick, safe, and cost effective. It requires no additional incision. Long-term follow up is required to determine the ultimate effectiveness of this method.
Subject(s)
Child , Humans , Follow-Up Studies , Hernia , Hernia, Inguinal , Herniorrhaphy , Inguinal Canal , Laparoscopy , Ligation , Surgical InstrumentsABSTRACT
PURPOSE: Epididymal anomalies in boys with an undescended testis have been well documented and most undescended testes are associated with patent processus vaginalis. However, the incidence of epididymal anomalies in descended testes has not well known. We performed a prospective study to determine the relationship between epididymal anomalies and patency of processus vaginalis in boys with hydrocele or cryptorchidism. MATERIALS AND METHODS: From January 1997 to February 1988, epididymal morphologies and the degrees of patency of processus vaginalis(closed, partially closed and open) were examined in 35 boys with hydrocele(37 testes) and 28 boys with cryptorchidism(29 testes) at the surgeries. RESULTS: No epididymal anomaly was found in all 3 hydroceles with closed processus vaginalis. Epididymal anomalies were found in 13 of 22 hydroceles with partially closed processus vaginalis and in 9 of 12 hydroceles with open processus vaginalis. All boys with undescended testes had open processus vagnialis and the epididymal anomalies were found in 27 of 29 undescended testes. The incidence of epididymal anomalies was highest in cryptorchid testes with open processus vaginalis and lowest in descended testes with closed processus vaginalis. Furthermore, epididymal anomalies were found to be more severe in association with more cranially located testes. CONCLUSIONS: The higher incidence of epididymal anomalies were associated with ipsilateral patency of processus vaginalis and testicular position. This finding suggests that the role of the epididymis in testicular descent may not be essential.
Subject(s)
Male , Cryptorchidism , Epididymis , Incidence , Prospective Studies , TestisABSTRACT
PURPOSE: Retrospective studies were carried out to clarify the incidence of contralateral occurrence after unilateral repair of hydrocele in children and the role of ultrasonography in preoperative recognition of asymptomatic hydrocele. MATERIALS AND METHODS: 452 patients of under 14 years old who underwent unilateral hydrocele repairs between January, 1990 and December, 1997 were reviewed. Patients with contralateral occurrence were defined as those who had previous unilateral hydrocele repairs and no clinical or historical evidence of contralateral hydrocele at the time of the initial repair Patients with simultaneous presence of bilateral hydrocele on their initial visit were excluded from this study. 36 patients who visited lately underwent ultrasonographic examination of both side of the groin and scrotum prior to surgery to identify asymptomatic contralateral hydrocele. RESULTS: The incidence of contralateral occurrence after unilateral hydrocele repairs was 5.4%(24 patients). When the left side was repaired initially, 13(7.4%) patients showed contralateral occurrence and when the right side was repaired initially, 11 (4.0%) patients showed contralateral occurrence. In the 36 patients who underwent ultrasonography, 2 patients(5.6%) had asymptomatic contralateral hydrocele and exploration revealed the presence of a patent processus vaginalis. On the other hand, 2 patients(5.6%) with negative ultrasonographic findings had contralateral repairs 1 month after clinically apparent hydrocele repair. CONCLUSIONS: Although the incidence was low, contralateral occurrence after unilateral repair of hydrocele in children was noted. Therefore, preoperative thorough history taking and physical examination in unilateral hydrocele patients should be performed. Also, in suspicious cases, inguinal or scrotal ultrasonography is helpful for the detection of the clinically occult contralateral hydrocele in children.
Subject(s)
Adolescent , Child , Humans , Groin , Hand , Incidence , Physical Examination , Retrospective Studies , Scrotum , UltrasonographyABSTRACT
Epididymal abnormalities have long been found in conjunction with undescended testis. Undescended testis with a patent processus vaginalis are associated with epididymal abnormalities, but the incidence of epididymal abnormalities in descended testis with a patent processus has not been reported. We analyzed the patency of processus vaginalis and epididymal abnormalities of 37 patients(41 testes) treated for undescended testes and 78 patients(79 testes) treated for hydrocele. Epididymal abnormalities ranged from simple epididymal elongation, epididymal angulation, disruption between testis and epididymal tail to more complex forms, such as epididymal/vasal atresia, complete disruption between the testis and epididymal head. Among 38 undescended testis with patent processus vaginalis 27(71%) had an epididymal abnormalities compared to 12 of 37(32%)hydroceles with patent processus vaginalis(P<0,05), and 12 of 38(329b) undescended testis with patent processus vaginalis had complex epididymal abnormalities(epididymal head separation and epididymal atresia) compared to 2 of 37(5%) hydroceles with patent processus vaginalis (p<0.05). Among 37 hydroceles with patent processus vaginalis 12(32%) had an epididymal abnormalities compared to 2 of 37(5%) hydroceles with incompletely patent processus vaginalis(P<0.05). These data suggest that epididymal abnormalities probably contribute to both testicular maldescent and closure of processus vaginalis.
Subject(s)
Male , Cryptorchidism , Head , Incidence , TestisABSTRACT
The incomplete obliteration of the processus vaginalis leads to the development of inguinal hernia in pediatric age, and its management is principally surgical repair. This study was a review and analysis of the usefulness of herniography on the hydrocele in pediatric age. From January 1985 to June 1989, 117 patients with unilateral hydrocele were studied to evaluate incomplete obliteration of the processus vaginalis. The over-all incidence of open processus vaginalis on the opposite side was 6.9% (8 of 117 cases), but the rate of patients who had past history of a palpable or visualized mass on the opposite side was 5%(3 of 12 cases). This finding would suggest that the herniogram is needed for the patients whose history is suspicious for hydrocele testis.
Subject(s)
Humans , Hernia, Inguinal , Incidence , TestisABSTRACT
The testis and its relative structures of 101 normal male fetuses (fetal-age 12-33 weeks) have been studied in this paper. The results were as follows: 1. The data of fetal growth of testis, epididymis and gubernaculum were given. 2. It has been found that there is no scrotum ligament existed. The gubernaculum is a mesenchyme tissue and is cylindrical pyramid in shape. Objectively, we cannot find any anatomical structure acted as a tractor in testis descending. 3. It has been found that the testis descends in chinese fetus between the 21th and the 25th week of fetal-age. It was completed in all of them after the 26th week. The time is more advanced than that of the traditional conception which referred to be between 7 th and 8 th month. 4. It has been confirmed that once the descent started, the testis run through inguinal canal rapidly. Generally, it seems that the testicular descent in left side is earlier than that in the right. From the above findings, the author suggests that it be necessary to correct the traditional conception in the Chinese anatomy book.