Is high ligation of the indirect hernia sac essential in inguinal hernioplasty?

To investigate the development and current status of the treatment of pediatric indirect inguinal hernia. Inguinal hernias include indirect hernias and direct inguinal hernias, but there are almost indirect inguinal hernias in children . Pediatric indirect inguinal hernia that the most common disease in pediatric surgery is almost caused by patent processus vaginali which incidence ranges from 0.8% to 4.4%.The treatment of pediatric indirect inguinal hernia reflects the process of pediatric surgery development, which from conservative non-surgical treatment to high ligation of the longitudinal incision hernia sac. In recent years, with the continuous improvement of medical level in China, laparoscopic technique has been applied in hospitals all over China, and laparoscopic high ligation of indirect inguinal hernia sac has become the standard for the treatment of pediatric indirect inguinal hernia.

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Two-center Analysis of Long-term Outcomes after High Ligation Inguinal Hernia Repair in Adolescents

The American Surgeon ◽

10.1177/000313481508101229 ◽

2015 ◽

Vol 81 (12) ◽

pp. 1260-1262 ◽

Cited By ~ 4

Author(s):

Alessandra C. Gasior ◽

E. Marty Knott ◽

Arielle Ranters ◽

Shawn D. Peter ◽

Todd A. Ponsky

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Recurrent Hernia ◽

High Ligation ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Hernia Sac ◽

Telephone Surveys ◽

Low Incidence

High ligation of the inguinal hernia sac is standard practice for many pediatric surgeons in post-pubertal adolescents. Most adult surgeons do not use this technique to repair indirect inguinal hernias because of concerns for higher recurrence rates compared with mesh repairs. Therefore, we examined long-term outcomes of adolescent high ligation hernia repair performed by pediatric surgeons. Telephone surveys were conducted on children over 12 years old at the time of repair, and patients and/or their parents were contacted 18 months postrepair. Patients were identified from two institutions between 1998 and 2010. The incidences of reoperation, recurrence, presence of bulge, chronic pain, or numbness were determined. A total of 210 patients (40.7% response rate) were available for phone interviews at 18.6 to 159.5 months postrepair. Mean age was 14.6 ± 1.8 (range: 12.0–19.0 years). Fourteen patients had pain (6.7%) and five had numbness (2.4%). There were four (1.9%) patients with a second operation, two of which confirmed a recurrent hernia. Three patients expressed concern about possible recurrence. Two report a bulge, but have not been evaluated. Pediatric hernia repair with high sac ligation appears effective in patients anatomically similar to adults with low recurrence rate and low incidence of chronic symptoms. These data suggest that prospective trials on the adequacy of high ligation in adults are warranted.

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Torsion of an indirect hernia sac within a hydrocele causing acute scrotum: case report and review of the literature

Pediatric Surgery International ◽

10.1007/s00383-006-1708-6 ◽

2006 ◽

Vol 22 (12) ◽

pp. 1025-1027 ◽

Cited By ~ 12

Author(s):

John W. Tillett ◽

James Elmore ◽

Edwin A. Smith

Keyword(s):

Case Report ◽

Acute Scrotum ◽

Review Of The Literature ◽

Indirect Hernia ◽

Hernia Sac

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Torsion of an indirect hernia sac: An unusual cause of acute scrotal swelling in children

Urology ◽

10.1016/s0090-4295(97)00297-5 ◽

1997 ◽

Vol 50 (3) ◽

pp. 432-435 ◽

Cited By ~ 16

Author(s):

Joseph Motta ◽

Darius J. Bagli ◽

John Van Savage ◽

Antoine E. Khoury ◽

Gordon McLorie ◽

...

Keyword(s):

Indirect Hernia ◽

Hernia Sac ◽

Scrotal Swelling

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Insufficiency of prosthetic posterolateral overlap related to recurrence after laparoscopic transabdominal preperitoneal inguinal hernioplasty, as assessed by video review

10.21203/rs.2.14796/v2 ◽

2020 ◽

Author(s):

Masanori Sato ◽

Masashi Nozawa ◽

Takahiro Watanabe ◽

Takanobu Onoda ◽

Atsuko Matsuyama ◽

...

Keyword(s):

Recurrence Rate ◽

Univariate Analysis ◽

Surgical Techniques ◽

Hernia Recurrence ◽

Indirect Hernia ◽

Inguinal Hernioplasty ◽

Transabdominal Preperitoneal ◽

Laparoscopic Hernioplasty ◽

Technical Factors ◽

And Control

Abstract Background: Technical factors leading to hernia recurrence after transabdominal preperitoneal repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding, or crinkling of the prosthesis. However, determining intraoperatively if a case will develop recurrent hernias due to these factors remains unclear. Methods: Five surgeons blind-reviewed operation videos of primary laparoscopic hernioplasty in 13 lesions that went on to develop recurrent hernias (i.e., future recurrence), as well as 28 control lesions, to assess twelve items of surgical techniques. Since we changed a surgical policy of covering myopectineal orifice (MPO) in April 2003, we analyzed the data for the earlier and later periods. The data was analyzed with hierarchical clustering to obtain a gross grouping. The differences of the ratings between the future recurrent and control lesions were then analyzed and the association of the techniques with the hernia recurrence rate, the size of the prosthesis, and the hernia type across hernia recurrence were explored. Results: The lesions were grouped based on the time series, and its boundary was approximated when we changed our surgical policy. This policy change caused ratings to progress from 34% satisfactory, to 79% satisfactory. The recurrence rate decreased to 0.7% (5/678), compared with 6.2% (10/161) before the policy was implemented ( p < 0.001). With univariate analysis, the ratings of posterior prosthesis overlap to the MPO in the recurrent lesions were significantly lower than controls in the later period ( p = 0.019). Although various types of recurrences were noted in the earlier period, only primary indirect and recurrent indirect hernias were observed in the later period ( p = 0.006). Conclusions: Fully covering the MPO with mesh is essential for preventing direct recurrence hernias. Additional hernia recurrence prevention can be obtained by giving appropriate attention to prosthesis overlap posterior to the MPO in a large indirect hernia.

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Single-site Laparoscopic High Ligation of the Extraperitoneal Hernia Sac with an Epidural Needle for Incarcerated Ovarian Hernia in Infants

10.21203/rs.3.rs-347452/v1 ◽

2021 ◽

Author(s):

Yunjin Wang ◽

Liu Chen ◽

Qiliang Zhang ◽

Jianqin Zhang ◽

Xu Cui ◽

...

Keyword(s):

Young Children ◽

Single Site ◽

Epidural Needle ◽

High Ligation ◽

Bladder Injury ◽

Hernia Sac ◽

Umbilical Incision ◽

Minimal Trauma ◽

Good Cosmetic ◽

Infants And Young Children

Abstract Background: The purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernia in infants and young children.Methods: The clinical data of 38 infants with incarcerated ovarian hernia who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.Results: All procedures were successfully performed in laparoscopy with no need for conversions to open surgery. All patients were discharged 1-2 days after the operation. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence and contralateral indirect hernia. However, three patients had complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma. Conclusions: Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernia in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

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Historical changes in recurrence forms and their mechanisms after laparoscopic transabdominal preperitoneal inguinal hernioplasty, as assessed by video review

10.21203/rs.2.14796/v1 ◽

2019 ◽

Author(s):

Masanori Sato ◽

Masashi Nozawa ◽

Takahiro Watanabe ◽

Takanobu Onoda ◽

Atsuko Matsuyama ◽

...

Keyword(s):

Univariate Analysis ◽

Surgical Techniques ◽

Hernia Recurrence ◽

Indirect Hernia ◽

Inguinal Hernioplasty ◽

Transabdominal Preperitoneal ◽

Tapp Repair ◽

Laparoscopic Hernioplasty ◽

Before And After ◽

Technical Factors

Abstract Background: Technical factors leading to hernia recurrence after transabdominal preperitoneal (TAPP) repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding or crinkling of the prosthesis. However, which of these can intraoperatively determine if a case will go on to develop recurrent hernias remains unclear. Methods: We reviewed operation videos for 27 control cases and primary laparoscopic hernioplasty of 13 lesions where the patient suffered recurrence after TAPP repair. Five surgeons blindly reviewed the videos to assess surgical techniques such as adequate dissection, mesh coverage, and folding or crinkling of the mesh. We explored the association of the technique with development of recurrence across our policy change, and hernia type before and after recurrence. Results: After implementing a TAPP repair policy of covering myopectineal orifice (MPO) with sufficiently overlapped mesh, 79% of the rating were satisfactory, whereas 34% were satisfactory prior to the policy. The recurrence rate decreased to 0.7% (5/678) compared with 6.2% (10/161) before the policy ( p <0.001). Although various types of recurrences were noted in the earlier period, only primary indirect and recurrent indirect hernias were observed in the later period ( p =0.006). With univariate analysis, the scores of posterior prosthesis overlap to the MPO in the recurrent cases were significantly lower than controls in the later period ( p =0.019). Conclusions: Fully covering the MPO with mesh is essential for preventing direct type recurrence. Prosthesis overlap posterior to the MPO in a large indirect hernia is important for preventing recurrence.

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