Laparoscopic Treatment of Inguinal Ovarian Hernia in Female Infants

Abstract

Introduction: Sliding indirect inguinal hernias containing ovary and fallopian tube are not uncommon in female infants.1,2 Ovaries trapped within inguinal hernias have a higher risk of torsion and infarction than those in the normal pelvic position.3,4 We report our experience with laparoscopic treatment of inguinal ovarian hernias in female infants. Materials and Methods: A total of 271 girls with an average age of 3.8 years [range 0–11.5] underwent laparoscopic repair of inguinal hernia in our unit for the past 5 years. Of these 271 girls, 32 had an ovary in the hernia sac. Of the girls with ovarian hernias, 5 (15.6%) were <1 month of age, 17 (53.1%) ranged in age from 2 months to 1 year, and 10 (31.2%) ranged in age from 2 to 5 years. From technical point of view, we always adopted three trocars: one 5- or 10-mm umbilical trocar for the 0° optic and two 3-mm screw trocars for the instruments. We usually placed the working ports on the same line with the optic port especially in newborns to obtain a larger working space. As for the operative technique, after reduction of the hernia content with both extracorporeal manipulation and intracorporeal maneuver using atraumatic graspers, ovary and fallopian tube were visually checked for any vascular damage. The abnormal attachment of the ovarian suspensory ligament over the internal inguinal ring (IIR), found in all patients, was divided with monopolar hook and the herniated adnexa recovered the normal pelvic position. After section of the periorificial peritoneum, the hernia orifice was closed with either a purse-string suture (Montupet's technique) or an N-shaped suture (Schier's technique) using nonresorbable sutures. The contralateral patency of the canal of Nuck was always checked and if present it was repaired accordingly. Written informed consent was obtained from all subjects participating in the study. Results and Conclusions: Average operative time was 23.7 minutes (range 18–43). No intraoperative necrotic ovary was found and all procedures were accomplished laparoscopically. No intraoperative nor postoperative complications were reported. A contralateral patency of canal of Nuck was found in 14 patients (43.7%). Average hospitalization was 21.8 hours (range 18–36). No hernia recurrence or ovarian atrophy at pelvic ultrasonography was recorded at a mean follow-up of 36 months (range 1–48). On the basis of our experience, we believe that ovarian hernias in female infants should be treated as soon as possible after their detection and laparoscopy should be considered the gold standard approach for their treatment. First of all, it allows a clear view of the hernia defect and identification of the abnormal attachment of the ovarian suspensory ligament over the IIR that attracts the ovary and fallopian tube in the hernia sac, found in all patients of our series. In addition, the laparoscopic approach allows to perform an easy and safe reduction of the herniated adnexa, to visually evaluate them for any vascular damage and finally to check the contralateral canal of Nuck for patency and to repair it during the same procedure, if patent. No competing financial interests exist. Runtime of video: 2 mins 49 secs