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RATIONALE@#There is a diversity of methods in performing pediatric inguinal herniotomy, but no consensus on which is the gold standard. The two most common are the Ferguson technique and the MitchellBanks technique. The objective of this meta-analysis was to compare the two techniques in terms of hernia recurrence and post-operative complications: namely hematoma, hydrocele, testicular ascent, and testicular atrophy.@*METHODS@#Three randomized controlled trials and one multi-center retrospective study were included in this meta-analysis. Using the Cochrane Collaboration tool and Newcastle-Ottawa quality assessment scale, all studies included were deemed to be of good quality and have low risk of bias. Revman 5.3 was used for all statistical analyses.@*RESULTS@#There was no significant difference in terms of hernia recurrence between the two techniques (OR = 0.85, 95% CI = 0.31- 2.36). For post-operative complications, hematoma (OR = 0.64, 95% CI = 0.37-1.13), testicular ascent (OR = 0.28, 95% CI = 0.05- 1.50), and testicular atrophy (OR = 2.02, 95% CI = 0.54-7.52) did not differ between the two techniques. Only the incidence of postoperative hydrocele significantly differed between the two techniques, being higher when the external oblique aponeurosis was opened (OR = 0.44, 95% CI = 0.27-0.70). @*CONCLUSION@# Performing pediatric inguinal herniotomy without opening the external oblique aponeurosis is a safe procedure and may be recommended as an optimal choice of method for uncomplicated cases.
ABSTRACT
Exstrophy of urinary bladder with epispadias involves protrusion of the urinary bladder through a defect in the lower abdominal wall accompanied by separation of pubic symphysis. It is a rare but challenging condition that causes significant physical, functional, social, sexual and psychological problems later in life. Bladder exstrophy commonly involves males and most cases are sporadic.' Inguinal hernia is a complication associated with bladder exstrophy and it occurs due to lack of obliquity of the inguinal canal secondary to pubic diastasis.' Authors report here, a case of antenatally diagnosed case of classic bladder exstrophy associated with left sided inguinal hernia which was incidentally diagnosed on tenth day of life. Our neonate underwent primary bladder closure with herniotomy. Staged reconstruction of epispadias and bladder neck has been planned at a later date. Recurrence of inguinal hernia after repair is common and bilateral inguinal exploration while performing herniotomy is advised to prevent its recurrence. Prognosis of such cases depends on the degree of continence achieved. With timely reconstructive surgery, continence rates can be as high as 60-70 percent.
ABSTRACT
Background: Laparoscopic cholecystectomy and laparoscopic appendectomy is gold standard treatment modality for symptomatic cholelithiasis and appendicitis. Laparoscopy in paediatric patient have many limitations and factors restricting its use in paediatric patient are smaller surface area for access, compliant abdominal wall, the liver margin below the rib cage, the bladder being an intra-abdominal structure, the viscera close to anterior abdominal wall and small sized abdominal cavity and conventional instruments too long for paediatrics use. The so-called obliterated structures like umbilical vein, umbilical artery and urachus remain relatively large and partially patent in infants further restricting use of therapeutic laparoscopy.Methods: The present study was carried out in Department of General Surgery, MDM Hospital, Dr. S. N. Medical College, Jodhpur, Rajasthan. Total 50 patients were included in the present study of laparoscopic surgery in paediatric patients below 14 years of age and were studied in terms of, duration of surgery, postoperative pain, analgesic requirement, postoperative hospital stay, intraoperative and postoperative complication and factors necessitating conversion of laparoscopic procedure to open method.Results: As per the present study inguinal hernia was most common diagnosis (48%) followed by hydrocele (22%) and acute appendicitis (22%).Conclusions: It is concluded from the present study that laparoscopic surgery in paediatric patients is safe, complication free, had less analgesic requirement, shorter duration of surgery, short postoperative hospital and total hospital stay and better cosmetic results.
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Introduction: Inguino-scrotal swellings are frequently observed in patients of pediatric age group. Inguinal hernia and Hydrocele are the most common causes of such swellings in children. For their effective management, it is essential to study various factors like age, sex etc. associated with inguinal hernia in pediatric age group. Objectives: To study the epidemiology, management and outcome of inguinal hernia in children. Methods: A prospective study was conducted on pediatric patients with inguinal hernia for a period of 18 months. Patients from newborn to 14 years of age were selected for this study on the basis of inclusion and exclusion criteria. Result: Inguinal hernia can occur at any age, but the majority of patients are seen between 1 to 5 years of age. It is more commonly seen in male children and incidence is slightly higher on right side. Almost all of the inguinal hernia in pediatric age group is of indirect type, which develops due to congenitally patent processus vaginalis. Conclusion: Early surgical intervention in form of Inguinal herniotomy is the most appropriate management of inguinal hernia in children.
ABSTRACT
Background: Inguino-scrotal swellings are frequently observed in patients of pediatric age group. Inguinal hernia and Hydrocele are the most common causes of such swellings in children. For their effective management, it is essential to study various factors like age, sex etc. associated with inguinal hernia in pediatric age group. Objectives: To study the epidemiology, management and outcome of inguinal hernia in children. Methods: A prospective study was conducted on pediatric patients with inguinal hernia for a period of 18 months, between February 2015 to July 2016. Patients from newborn to 14 years of age were selected for this study. Results: Inguinal hernia can occur at any age, but the majority of patients are seen between 1 to 5 years of age. It is more commonly seen in male children and incidence is slightly higher on right side. Almost all of the inguinal hernia in pediatric age group is of indirect type, which develops due to congenitally patent processus vaginalis. Conclusion: Early surgical intervention in form of Inguinal herniotomy is the most appropriate management of inguinal hernia in children.
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.
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Introduction: Incarceration of an indirect inguinal hernia in children is an acute emergency and one of the common complications that may occur before herniotomy. Inguinal hernias rarely go away, and therefore, virtually all should be repaired at any age of presentation. Incarcerated inguinal hernia can be reduced successfully by manual reduction if performed by experienced hands on time. The objective of this study was to assess the safety and efficacy of manual reduction of incarcerated indirect inguinal hernia. Materials and Methods: Thirty six patients who attended Emergency Department of Kanti Children’s Hospital over 30 months period from January 2009 to July 2011 were studied prospectively. All patients were diagnosed case of inguinal hernia and waiting for elective herniotomy. Results: There were 30(83.33%) males and 6(16.66%) females, with male-to-female ratio of 5:1. Right sided inguinal hernia was 20(55.5%) and left 16(44.44%). The ages ranged from 1.5 months to 28 months with mean age of 15 months. Time of incarceration ranged from 3 hours to 30 hours. Manual reduction was successful in 30(83.33%). Remaining six had to undergo emergency surgery. Four patients with edematous but viable hernial contents had successful surgical reduction. Two patients with gangrenous small bowel loops had bowel resection and anastomosis. Conclusion: Manual reduction is safe and effective when performed timely. Herniotomy should be done without delay once diagnosed to avoid unnecessary complications.
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Ojective To investigate the application of mini-laparoscopic herniotomy to the treatment of inguinal hernia in infants and children. Methods With the help of mini-laparoscope 600 children with indirect inguinal hernia were treated by purse-string ligature using lift-insert suture method from August 1998 to December 2000. Results There were 5 recurrences out of 600 cases, the recurrence rate being 0.83%, which was lower than that by the traditional method. Conclusions The principle of mini-laparoscopic herniotomy is sound and it is simple and convenient to handle. Small incision and minimal injuzy thought of as its additional advantages.