Ligation of Processus Vaginalis During Orchidopexy: Is It Mandatory?

Introduction: Undescended testis is one of the commonest presentations in pediatric population. Conventionally, high ligation of the hernia sac was done after vas and vessels were dissected in order to prevent post-operative hernia. However, recent studies have shown that hernia sac ligation was unnecessary. Aims: To evaluate the role of hernia sac ligation during orchidopexy to prevent the development of postoperative hernia and to compare the mean operative time with and without sac ligation. Methods: A prospective comparative study was conducted with a total of 94 patients with undescended testis, age ranging from six months to 16 years were included in the study from November 2018 to May 2021. Cases were randomly divided into two groups. In Group A cases, orchidopexy was carried out with sac ligation, while in Group B, the hernia sac was not ligated. Mean operative time was recorded in each case. All the patients were followed up at one, four and eight weeks post-operatively and examined for postoperative hernia. Results: Of the total 94 cases, there were 18 bilateral and 76 unilateral cases of which 56 were right-sided and 22 left-sided. Most of the patients (45) of the study were between six months and 2 years. None of the patients of either group developed post-operative hernia or any significant complications. The mean operative time for group A and B were 36.72 and 46.96 minutes respectively. Conclusion: It was concluded that ligation of processus vaginalis was unnecessary during orchidopexy and sac ligation consumed more operative time.

Rare Case report of Amyand's Hernia in a Premature Infant

Although inguinal hernias are a common finding in premature infants, it is usually caused by the protrusion of the bowel through a persistent patent processus vaginalis. However, acute appendicitis in association with an inguinal hernia in this age group is a rare finding. This type of hernia is referred to as an Amyand hernia.

TP7.2.6 Frequency of Obstructed Inguinal Hernia in Infants

Inguinal hernia in children is the result of the failure of obliteration of processus vaginalis or weakness of the abdominal wall. The incidence of inguinal hernia ranges from 0.8-5%. It is more common in preterm babies with an incidence of up to 30%.There is disagreement concerning the management of inguinal hernia in infants worldwide with few in favor of early repair of the hernia due to fear of incarceration while some are against it. This study was conducted to determine the frequency of intestinal obstruction in infants with an inguinal hernia for the development of a proper protocol for the management of inguinal hernias. Methods A total of 112 patients were included in the study. The patient’s gender and age were recorded. The presence of hernia was confirmed clinically and by performing an ultrasound. All the relevant data was recorded in a pre-designed printed proforma. Results In this study, 112 children were included. 73% of children were in the age between 1-6 months and 27% children were in age between 7-12 months. The mean age was 5 months ±5.87. Male children were 86% and female children were 14%. An obstructed inguinal hernia was observed in 11% of children while 89% of children didn’t have obstructed inguinal hernia. Conclusion Our study concludes that the frequency of incarcerated inguinal hernia was 11% in infants mostly occurring at a younger age and in male children.

Umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis in boys: incision-hiding and solo-like surgery

Background Transumbilical two-port laparoscopic percutaneous extraperitoneal closure for the treatment of processus vaginalis patency in boys has been practising recent years. The applicable instruments and skills are still evolving. In this study, we used a self-made needle assisted by a disposable dissecting forceps to practise this minimal invasive method for patent processus vaginalis in boys. Its safety and effectiveness were studied. The methods for depth and orientation perceptions were analyzed. Methods From January 2020 to November 2020, boys characteristic of symtomatic patency of processus vaginalis were performed open surgery consecutively. From December 2020, the authors begun to propose transumbilical two-port laparoscopic percutaneous extraperitoneal closure for this kind of boy patients. The open group included fifteen boys and the laparoscopic group included ten ones. The data of the patients age, constituent ratios of unilateral and bilateral patency, operating time, postoperative stay in hospital, follow-up time, conversion, postoperative complications were assessed. Throughout the laparoscopic process, the parallel and synchronous movements of lens pole and dissecting forceps were maintained. Vas deferens protrude was imagined as one of the point to form the triangular manipulation plane. Results There were no statistically significant difference between the laparoscopic group and the open group for the following items: age, operating time, the constituent ratios of unilateral or bilateral patency of processus vaginalis (P > 0.05). Postoperative stay in hospital and follow-up time of the laparoscopic group was significantly shorter than that of the open group (P = 0.0000). No laparoscopic case was converted to open surgery. After 10 cases of laparoscopic practice, orientation perception was established. There were no postoperative complications for all the patients. Conclusion Our preliminary experience suggested that umbilical two-port laparoscopic percutaneous extraperitoneal closure is safe and convenient for patent processus vaginalis treatment in boys. It has the advantage of incision-hiding and can be manipulated like a solo-like surgery.

Cyst of canal of Nuck-a rare clinical entity: case series and review of literature

A small evagination of parietal peritoneum forms the canal of Nuck. By the first year of life this extension condenses into a fibrous cord. Cyst of canal of Nuck is a rare developmental anomaly. The inguinal canal is traversed by the spermatic cord in male and the round ligament of uterus in female. The processus vaginalis accompanies the round ligament through the inguinal canal through into the labium majus. This evagination of parietal peritoneum forms the canal of Nuck in the female. These cases are rarely seen in surgical practice. In this case series we described three clinical scenario of canal of Nuck and their management.

A Comprehensive Review: Molecular and Genetic Background of Indirect Inguinal Hernias

<b><i>Background:</i></b> The occurrence of indirect inguinal hernias (IIH) is 5 times more prevalent than that of direct inguinal hernias (IH) and it is 7 times more common in males, owing to the attendance of the processus vaginalis (PV) throughout testicular descent. <b><i>Summary:</i></b> In children, the immense mainstream of IH is indirect. The progress of IIH development in children is instigated with a patent PV, which is mostly treated by simple herniorrhaphy. Syndromes of the collagen, microfibril, elastin, and glycosaminoglycan constituents of the extracellular matrix may attend to the development of IH. Our recent research showed that the lack of epithelial-mesenchymal transition (EMT) in children contributes to the development of IIH, while the scenario is defined as the opposite in adults. However, there is still a lack of knowledge on all of the genetic and molecular causes of the disease. <b><i>Key Messages:</i></b> Here we aimed to review the published genetic background of IH, the deficiencies of connective tissue causing the disease, recently defined molecular pathways involved including EMT, and possible recurrence reasons. This comprehensive study can deliver an analytic outline aiding to define patients with IH combined with fundamental genetic diseases.