Inguinal and Femoral Hernias and Hydroceles (original) (raw)
Related papers
A Study of Inguinal Hernia in Infants and Children
Annals of International medical and Dental Research, 2016
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.
Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary center
Journal of Pediatric Surgery, 2013
Background/Purpose: This study describes the pediatric inguinal hernia and hydrocele experience of a tertiary care training hospital. Methods: A total of 3776 patients who had been operated between January 2005 and June 2009 for inguinal hernia, cord hydrocele, and hydrocele were included. The surgeries and patient follow-up were performed by 6 pediatric surgery specialists and 8 pediatric surgery residents. Results: The patient age varied from 6 days to 17 years. There were 2959 (78.4%) males and 817 (21.6%) females (ratio: 3.6:1). The hernia was on the right in 2306 (61.1%) patients, on the left in 1111 (29.4%) patients, and bilateral in 359 (9.5%) patients. Age at presentation was younger in males (pb.001). Contralateral hernia repair was required later on during follow-up in 2% of the patients. Postoperative complications developed in 1.2% of the patients. Reoperation was needed because of wound infection in 0.6%, recurrence in 0.4%, hematoma in 0.1%, testicular atrophy in 1 patient, and acquired undescended testis in 1 patient. Conclusions: The age of first hernia symptoms was younger in males compared to females and in premature babies compared to term babies (pb.05). The recurrent hernia rate was higher in infancy. The complication rate was higher in hernia surgery in the newborn period and in cases of incarcerated hernia compared to the overall rate (pb.05). There was no indication for contralateral routine exploration.
ABC of General Paediatric Surgery: INGUINAL HERNIA, HYDROCELE, AND THE UNDESCENDED TESTIS
BMJ, 1996
Clinical embryology and anatomy of the inguinal region dutomna '~The testis is formed from coelomic epithelium and primordial germ cells in a longitudinal fold high on the posterior abdominal wall at a similar level to the developing kidneys. As gestation proceeds, the testis migrates down the posterior wall towards the deep inguinal ring, probably under the control of the hormone mullerian duct inhibitory factor. The gubernaculum, a condensation of mesenchyme, forms _ within the future inguinal canal and guides the testis through the layers i_______ of the body wall towards the scrotum. Two factors seem to be important in this second stage-the release of testosterone from the fetal testis itself and an intact genitofemoral nerve, which probably-\ l <; releases substances causing gubernacular contraction. A tongue of the peritoneal cavity also precedes the migrating testis through the canal-the processus vaginalis. After birth this peritoneal communication should obliterate and disappear, but failure to do this may lead to two of the commonest problems of this region, hernias and .....%'..%-. hydroceles. Anatomy of the processus vaginalis. Inguinal hernias Anatomically these are virtually all indirect and often complete (that is, the sac comes all the way to the scrotum). Infantile hernias occur in about 1-2% of births and are much more common in premature babies than in full term infants. They appear as an intermittent, usually reducible, lump in the groin. The correct management is a surgical herniotomy when the child's condition allows. In most uncomplicated cases this should be within two or three weeks of diagnosis. Infant
Inguinal hernia and occurrence on the other side: a prospective analysis in Iran
Hernia, 2009
Background Indirect inguinal hernia (IH) is the most common type of hernia. Routine contralateral inguinal exploration, without clinical evidence of a hernia is still controversial especially in children. The purpose of our study was to determine incidence of contralateral IH. Methods This is a prospective study of 301 patients during a one-year period. History of groin mass, positive findings, demonstrable hernia, or communicating hydrocele were our criteria for diagnosis. Results Our study includes 301 infants and children, 270 (89.7%) males and 31 (10.3%) females with mean age of two years and 40.9% under six months. In the follow-up period, we found 33 new IH in our patients. 23 (12%) of 196 patients less than two years old underwent contralateral herniorrhaphy in the follow-up period (P = 0.02). Six patients of 30 premature children underwent contralateral herniorrhaphy (P = 0.03). Conclusion The incidence of contralateral hernia is approximately 10% and in our study it is approximately 1.7%. There is a significant difference between the occurrence of contralateral hernia in preterm compared with term infants (P = 0.03). We think that the incidence is still too low to recommend routine contralateral exploration.
Background:Inguinal hernia repair is one of the most common pediatric operations performed nowadays. Majority are right sided indirect hernias and common in male gender. 1,2 Presentation varies from asymptomatic to life threatening complications. Operations are usually done under general anesthesia in an elective setting but the acute presentations like obstruction or strangulation are managed in emergency. Objectives:To see the clinical presentation and management outcome of congenital inguinal hernia cases who presented in the Pediatric Surgery Department of Qurrayatcentral hospital, Northern province, Kingdom of Saudi Arabia. Subjects and Methods: 4 years descriptive study of pediatric patients with inguinal hernia in Central hospital of Qurrayat city, Kingdom of Saudi Arabia, excluding patients with comorbidities or congenital malformations. Data included age, gender, clinical presentation, involvement (unilateral or bilateral), content of the sac, associated conditions, operative choice (elective or emergency) and complications after operation. Data analysis was done using statistical package SPSS version 16. Results: In 4 years, 520 patients (Male to female ratio 7:1) presented with inguinal hernia, majority less than 1 year (55%) with right sided predominance (56.5%). Undescended testis in 12(2.4%) and hydrocele in 9(1.8%) were the associated conditions. Some cases presented with contents like large intestine (5.2%), appendix (0.8%), testis (0.6%) and small intestine or ovary (0.4%) while 11.3% came in emergency as strangulated hernias. After operation, nearly all cases (98.5%) passed without complications, recurrence occurred in 6(1.2%) cases and 2(0.4%) cases were complicated by wound infection, seen in older aged patients. Sac containing large intestine or appendix presented with complications. Conclusion: In this study the trend of presentation was more in children less than a year in age, with male predominance, and in most cases right side was involved, complications were less frequent but seen in older children, in emergency cases and when the sac contents were large intestine or appendix.
Inguinal hernia in premature boys: should we systematically explore the contralateral side?
Journal of Pediatric Surgery, 2014
Bilateral surgery has been largely advocated in premature boys with unilateral inguinal hernia owing to the high incidence of contralateral patent processus vaginalis. Recently, the potential morbidity of herniotomy in low birth-weight babies and the progress in pediatric anesthesia questioned this attitude. This study aims to evaluate the incidence of contralateral metachronous hernia in a large series of premature boys and to compare the morbidity of preventive versus elective surgery. Methods: This retrospective multicenter analysis of 964 premature boys presenting with unilateral inguinal hernia operated from 1998 to 2012 included 557 infants who benefited from a unilateral herniotomy and 407 from a bilateral herniotomy (median follow-up 12 months). Results: Contralateral metachronous hernia after unilateral surgery occurred in 11% (n = 60) without significant difference according to the initial symptomatic side (9.5% on right vs 13% on left, p N 0.05). Postoperative morbidity on the contralateral side was higher after preventive surgery than elective surgery with metachronous hernia (2.45% versus 0.9%, p = 0.05) especially for secondary cryptorchidism (1% vs 0%, p = 0.03). Despite the risk of metachronous incarcerated hernia, elective surgery did not increase the rate of testicular hypotrophy on the opposite side (0.7%, vs 0.7%, p N 0.05). Conclusion: Systematic bilateral herniotomy is unnecessary in almost 90% of patients and has a significant morbidity. Secondary surgery for metachronous hernia does not increase the risk of testicular lesion and even reduces the risk of secondary cryptorchidism. These results, along with the risk of hypofertility reported after bilateral surgery, may justify treating only the symptomatic side in premature boys.
Inguinal hernia in children: and Indian experience
Pediatric Surgery International, 1993
In India, due to the limited pediatric surgical services available, the majority of the patients with indirect inguinal hernia (IIH) are managed by general surgeons. Between January 1986 and June 1992, at a tertiary care level center, 392 children with inguinal hernia were seen from 0-12 years of age (4.5% of all pediatric surgical procedures). Sixty-five percent Of these presented when below 5 years of age. The majority of these (376, 96%) were boys. There were 212 (54%) right sided, 150 (38.3%) left sided and 30 (7.7%) bilateral hernias. Eighteen children (4.6%) presented with incarceration, and 6 of these required intestinal resections. The results following surgical repair were excellent, Contralateral exploration was reserved for babies under 6 months of age and girls (intersex disorders excluded). In a non-teachiug hospital in Delhi inguinal hernias constituted 12.5% of all surgical procedures. Most of the children were over 1 year of age and only the symptomatic inguinal hernias were operated upon, without a policy for contralateral exploration. Due to the high risk of incarceration in premature babies, a careful search for the presence of inguinal hernia is recommended.
Management of Inguinal Hernia in Pediatric Age Group
Iraqi Journal of Pharmacy, 2019
Introduction: Incidence of indirect inguinal hernias in premature infants is reported to be as high as 30% with male predominance. Typically, inguinal hernia repairs are done under general anesthesia which has a high risk of post-operative complications, especially in the premature infant. The purpose of this study was to compare outcomes between early (neonatal) and delayed (older) inguinal hernia repair. Method: This is a prospective study in the department of pediatric surgery in alkhansaa Teaching Hospital Mosul / Iraq during a period from Jul 2018 to Dec 2019. All children with inguinal hernia were selected for the study and divided in two groups, those below one month and those above. Surgery is performed under general anesthesia with extracanalicular approach. Post-operative complications were observed and finally decided to discharge once patient is fit for discharge on the same day. Results: During the 18 months' period, we underwent 93 inguinal hernia repair those babies were divided into two groups, neonatal group (23 neonates) and older group (70 babies). The gender distribution ratio is 7.8 male :1 female. The side distribution among those babies in the neonatal group were 14,6 and 3 as right, left and bilateral respectively. In the neonatal group there were 9 babies presented with incarceration two (8.6%) of them shows testicular infarction and necrosis which necessitate excision at exploration while the other one atrophied in the period of follow up. We do not record any anesthetic complications or mortality in neonatal group in our period of study.
Hernia Survey of the Section on Surgery of the American Academy of Pediatrics* 1
Journal of pediatric …, 1996
The members of the Section on Surgery of the American Academy of Pediatrics were surveyed to determine the practice of North American pediatric surgeons in infants with inguinal hernia (IH). Case-scenario multiple-choice-design questionnaires regarding hernias and hydroceles were sent to all members of the Surgical Section, and responses were received from 292 (50%). In healthy full-term infant boys with asymptomatic reducible IH, 82% of responders perform repair electively, no matter what the age or weight. In full-term girls with a reducible ovary, 59% perform surgery at the next available time; if the ovary is nonreducible but asymptomatic, 44% operate emergently or urgently and 42% at the next elective slot. In former preemies, the pattern of repair is as follows. (1] For those recently discharged after 2 months in the neonatal intensive care unit (NICU) with reducible IH, 65% perform the repair when convenient. (2) A general anesthetic is used in 70%; 15% use spinal anesthesia, and 11% use caudal block with sedation. (3) If the repair is done in the hospital outpatient (same-day) unit, 36% wait until 50 weeks postconception (PC) and 33% wait until 60 weeks PC. (4) If the baby's weight is at least 1,000 g, 71% perform the repair before discharge. The pain control choice after childhood IH repair is Tylenol for 30%, local infiltration biquivacaine for 30%, caudal block for 22%, regional block for 11%, and Tylenol/codeine combined for 7%. In 6-weekold full-term infants with communicating hydroceles without definite "hernia," two thirds treat as an IH with elective repair as soon as possible. With respect to contralateral exploration in infants with unilateral IH, 65% perform it in males if they are _<2 years of age and 84% use it in females of up to 4 years of age. This approach is not influenced by presenting side, presence of hydrocele, or history of prematurity. LaParoscopic evaluation of the contralateral IH is performed by only 6% of responders, 40% of whom use the open ipsilateral sac for laparoscope introduction.
Inguinal Hernia in Female Children - a Case Series of 19 Patients
Zenodo (CERN European Organization for Nuclear Research), 2023
Background;Inguinal hernia is quite uncommon in females as compared to males and may pose a diagnostic as well as a surgical challenge to the surgeons. Thorough knowledge of the anatomy of the region and the variable nature of contents is essential to prevent any complications. The cumulative incidence of inguinal hernia from birth to 15 years of age has been reported as 6.62% in males and 0.74% in females. Aims and objectives;The aim of the study was to study the clinical profile and management of inguinal hernia in female children. Material and methods;Thestudy,"Inguinal Hernia in Female Children-A case series of 19 patients' was conducted prospectively in the department of Surgery at Sheri-Kashmir Institute of Medical Sciences Medical College Srinagar from March 2017 to February 2022. All the female children in the age group of 1 to 14 years who presented with clinical or Sonographic evidence of inguinal hernia were included in the study. Results and observations; Total number of patients studied was nineteen. All the study patients had indirect inguinal hernia, with right sided hernia in 8 (42.10%), left sided hernia in 10 (52.25%) patients and bilateral hernia in one patient(5.26%).At the time of surgery, indirect sac alone was found in 50% patients, indirect sac containing omentum was seen in 18.75% patients and a sac containing small bowel was seen in 25% patients.One patient had a sliding hernia containing ovary and fallopian tube. All the patients underwent herniotomy under general anesthesia. Conclusion; Thorough knowledge of female inguinal anatomy is essential before attempting any surgical intervention for inguinal hernia. The possibility of a sliding inguinal hernia with uterus, fallopian tube and ovaries should be considered and may present as an incarcerated inguinal hernia in females.Herniotomy is the surgical procedure of choice in all patients.