Laparoscopic Strategy for Inguinal Ovarian Hernias in Children: When to Operate for Irreducible Ovary

Abstract

Sliding indirect inguinal hernias containing the ovary and fallopian tube are not uncommon in younger girls. Although an irreducible ovary is not at great risk of incarceration, this condition may become a significant risk factor for torsion or strangulation. This paper describes the indications for surgery in children with irreducible ovaries. There were 650 children (413 boys and 237 girls) with inguinal hernias treated with laparoscopic percutaneous extraperitoneal closure (LPEC) over a period of 12 years and 7 months. Of 237 girls with inguinal hernias, 46 had an ovary in the hernial sac, and 15 of these (age range, 4 weeks to 4 years) had irreducible ovarian hernias. Eleven were corrected laparoscopically, and their hernial orifices were repaired by LPEC. Their ovaries revealed edematous enlargement at surgery. One who was awaiting elective herniorrhaphy developed a strangulated ovarian hernia, and she needed salpingo-oophorectomy.The remaining three were corrected laparoscopically by cutting the external inguinal ring with a small skin incision.There was a high incidence of irreducible ovaries (32.6%) among younger girls with ovarian hernias,and four of them developed incarcerated ovaries. Many irreducible ovarian hernias can be corrected laparoscopically, and their hernial orifices are easily repaired by LPEC. We strongly emphasize that irreducible ovarian hernias should be treated by LPEC,as soon as possible after they are detected.