Management and outcome of pediatric inguinal hernias with emphasis on technique without opening the inguinal canal- a single center experience

Authors

  • Rajesh Girdhar Department of Surgery, Military Hospital, Bathinda, Punjab, India
  • Ikjot Singh Department of Anesthesiology, Military Hospital, Bathinda, Punjab, India
  • Achinta Kumar Mallick Department of Pediatrics, Military Hospital, Bathinda, Punjab, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20233020

Keywords:

Congenital inguinal hernia, Herniotomy, Inguinal canal, Open repair for inguinal hernia

Abstract

Background: Herniotomy for congenital inguinal hernia in children is a fairly common surgical procedure. Inguinal hernias in infants can be repaired by conventional surgery as well as laparoscopic approach. Open repair of inguinal hernias in children without opening the inguinal canal, thereby maintaining the normal anatomy was done at our centre. Objective was to evaluate the course and outcome of paediatric congenital inguinal hernia cases operated at our centre.

Methods: This study was conducted in a service hospital (Military Hospital Jammu), on 67 patients presenting with congenital inguinal hernia during October 2014 to June 2017.

Results: Sixty-two children were male and five were female. 18 were less than one year, 38 between two to five year and 11 more than five years. All the patients were evaluated preoperatively and taken up for surgery under general anesthesia (n=18) spinal block (n=36) and caudal anesthesia (n=13). Approximate length of skin incision was 1.5 to 2.0 cm. External inguinal ring was opened in 3 cases only. Approximate postoperative stay in hospital was 1-2 days. Nine patients had reactive hydrocele and one patient developed surgical site infection (SSI). On 12 months post-operative follow up, none of the patients had any further complications.

Conclusions: Inguinal hernias are common in children, with increased risk of incarceration if not repaired early. Open technique without altering the inguinal canal anatomy is also a suitable alternative to congenital inguinal hernia repair in children with favourable comparable outcome.

References

Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am. 2008;45:773-85.

Nazem M, Heydari Dastgerdi MM, Sirousfard M. Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia. J Res Med Sci. 2015;20:1172-6.

Grosfeld JL. Current concepts in inguinal hernia in infants and children. World J Surg. 1989;13(5):506-15

Acharya H, Agrawal R, Agrawal V, Tiwari A, Chanchlani R. Management of inguinal hernia in children: a single center experience of 490 patients. Int Surg J. 2016;3:345-8.

Hughes IA, Acerini CL. Factors controlling testis descent. Eur J Endocrinol. 2008;159(suppl 1):S75-82

Beasley SW, Hutson JM. The role of the gubernaculum in testicular descent. J Urol. 1988;140(5 pt 2):1191-3.

Skandalakis JE, Colborn GL, Androulakis JA, Skandalakis LJ, Pemberton LB. Embryologic and anatomic basis of inguinal herniorrhaphy. Surg Clin North Am. 1993;73(4):799-836.

AlShareef Y, Sourial M, Hutson JM. Exogenous calcitonin gene-related peptide perturbs the direction and length of gubernaculum in capsaicin-treated rats. Pediatr Surg Int. 2007;23(4):305-8.

Ting AY, Huynh J, Farmer P, Yong EX, Hasthorpe S, Fosang A, et al. The role of hepatocyte growth factor in the humoral regulation of inguinal hernia closure. J Pediatr Surg. 2005;40(12):1865-8.

Hutson JM, Temelcos C. Could inguinal hernia be treated medically? Med Hypoth. 2005;64(1):37-40.

Brandt ML. Pediatric hernias. Surg Clin North Am. 2008;88(1):27-43, vii–viii.

Snyder WH. Pediatric Surgery. Vol 1. Chicago, IL: Year Book Medical Publishers; 1962.

McGregor DB, Halverson K, McVay CB. The unilateral pediatric inguinal hernia: Should the contralateral side by explored? J Pediatr Surg. 1980;15(3):313-7.

Zamakhshary M, To T, Guan J, Langer JC. Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery. CMAJ. 2008;179(10):1001-5.

Vaos G, Gardikis S, Kambouri K, Sigalas I, Kourakis G, Petoussis G. Optimal timing for repair of an inguinal hernia in premature infants. Pediatr Surg Int. 2010;26(4):379-85.

Lautz TB, Raval MV, Reynolds M. Does timing matter? A national perspective on the risk of incarceration in premature neonates with inguinal hernia. J Pediatr. 2011;158(4):573-77.

Lee SL, Gleason JM, Sydorak RM. A critical review of premature infants with inguinal hernias: optimal timing of repair, incarceration risk, and postoperative apnea. J Pediatr Surg. 2011;46(1):217-20.

Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg. 2006;41(5):980-6.

Skinner MA, Grosfeld JL. Inguinal and umbilical hernia repair in infants and children. Surg Clin North Am. 1993;73(3):439-49.

Harvey MH, Johnstone MJ, Fossard DP. Inguinal herniotomy in children: a five year survey. Br J Surg. 1985;72(6):485-7.

Hecker WC, Ring-Mrozik E. Results of follow-up of operations in pediatric patients with indirect inguinal hernia. Langenbecks Arch Chir. 1987;371(2):115-21.

Wilder RT, Flick RP, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, et al. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;110(4):796-804.

Ravikumar V, Rajshankar S, Hareesh RS, Nagendra GM. A clinical study on the management of inguinal hernias in children on the general surgical practice. J Clin Diagn Res. 2013;7(1):144-7.

Ramanathan SB, Arora M, Baskaran V. Pediatric inguinal hernia laparoscopic versus open surgery. JSLS. 2008;12(3):277-81.

Chan KL, Hui WC, Tam PKH. Prospective, randomized, single centre, single blind comparison of laparoscopic vs open repair of pediatric inguinal hernia. Surg Endosc. 2005;19:927-32.

Downloads

Published

2023-09-29

How to Cite

Girdhar, R., Singh, I., & Mallick, A. K. (2023). Management and outcome of pediatric inguinal hernias with emphasis on technique without opening the inguinal canal- a single center experience. International Journal of Research in Medical Sciences, 11(10), 3691–3695. https://doi.org/10.18203/2320-6012.ijrms20233020

Issue

Section

Original Research Articles