Congenital Inguinal Hernia Research Articles

A curious case of toddler with hernia and much more

Transverse testicular ectopia (TTE) with fused vas deferens is an extremely rare clinical entity. Herein, we presented a case of a 2 years old patient with left inguino-scrotal swelling associated with pain lasting for 3 days. Clinical examination revealed an empty right hemi-scrotum, a left-sided giant inguino-scrotal swelling. Laboratory tests were normal. Ultrasound imaging (US) of the scrotum demonstrated the presence of both testes in the same left hemi-scrotum with inguinal hernia and enterocele as content. Surgical intervention in suspicion of obstruction was carried out through inguinal incision. There was a congenital inguinal hernia with appendix (type 1-Amyand’s hernia) and cecum as content with two well developed testes on the same side with separate epididymis and vas deferens. Both the testes were united by a mesorchium. Hence, reduction of contents with herniotomy and both the testes were anchored to inner aspect of left thigh one above the other. We reviewed the literature for rare diagnosis of TTE.

Laparoscopic and needlescopic hernia repair for pediatric inguinal hernia: A systematic review with meta-analysis

Background: congenital inguinal hernia is considered to be among the commonest paediatric surgical procedures in daily practice. Open herniotomy with high ligation is of the hernial sac is the gold standard treatment against which all modalities of laparoscopic repair should be compared. With the advances of minimally invasive laparoscopic techniques, less complications and better cosmesis has become the point of study. Objective: was to review the current literature about laparoscopic and needlescopic techniques and highlighting its surgical outcomes. Data source: English midline search using the keywords inguinal hernia, paediatric age, laparoscopy, minimally invasive surgery, needlescopic repair in PubMed, Google scholar, research gate and science direct during the period 1997- 2020. Study selection: article of high quality, randomised controlled trial are only included Data extraction: data were collected, organised according the type of study and extracted systematicallyfrom these studies Data analysis: performed with the IBM SPSS 20.0 software. Conclusion: Laparoscopy has become a good substitution for the open method in the last years due to its advantages and by time minimally invasive manoeuvres became a good substitution for the conventional type of laparoscopic repair as they are easier for the laparoscopic beginners, carry less learning curve, almost have the same results, recurrence rate and have better cosmoses.

Comparative study: repair of congenital inguinal hernia with and without opening the inguinal canal

Background: Inguinal herniotomy is the most common surgery performed by paediatric surgeons.Methods: 100 Male and female cases with congenital inguinal hernia aging from one month till the age of two years. randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal oedema and hematoma, and wound infections classified as early complication. The rates of mentioned early complications and operative time were compared in the two interventional groups. In this study, 100 cases were selected and allocated to the two interventional groups.Results: The prevalence of early complications in two studied groups were not different significantly in two interventional groups. Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied techniqueConclusions: The findings of our study indicated that though early complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle both methods are safe and feasible, choosing one of them depend on surgeon prefer.

Irreducible Hernia in Female Children Containing Ovary, Uterus or Uterine Adnexa: Case Series

Inguinal hernias are the most frequent hernias of childhood. They are relatively uncommon in females as compared to males. Congenital inguinal hernias are due to the failure of closure of processus vaginalis. In females, this usually obliterates around the eighth month of foetal life. When these remain patent, a rare but possible herniation of contents can occur through this, like the genito-urinary system, including the ovaries and sometimes the fallopian tubes. However, the occurrence of uterus as one of the contents is a rare entity. This is a case series of six such cases with various genital tract entities as contents in paediatric female inguinal hernia. In conclusion, the rare entity of uterus, uterine adnexae and ovaries being a content of inguinal hernia has to be kept in mind when treating female children.

Mesothelial cyst in inguinal hernial sac in a male child: a case report

Mesothelial cysts of inguinal area are extremely rare and few cases have been reported in females, arising from round ligament of uterus. Inguinal hernias are a common surgical problem in children presenting as an inguinal or inguino scrotal swelling. Usually the contents of hernial sac in a male child are intestine or omentum and in females it may contain ovary. Mesothelial cyst of round ligament may present as an inguinal mass in females, but it is very rare to find in side inguinal hernial sac of a male child. Here in we report a case of 2 year 9-month-old male child, who was operated for irreducible right congenital inguinal hernia. A pedunculated cystic mass was found to be the content and was removed. Histopathology confirmed the diagnosis of mesothelial cyst. Because of rarity, we report this case.

Preemptive analgesic efficacy of ultrasound-guided transversalis fascia plane block in children undergoing inguinal herniorrhaphy: a randomized, double-blind, controlled study.

BackgroundSurgical repair of congenital inguinal hernia results in significant postoperative discomfort and pain. The aim of the current study was to evaluate the pre-emptive analgesic efficacy of a transversalis fascia plane (TFP) block after pediatric inguinal herniorrhaphy.MethodsForty-four patients aged 12 to 60 months who underwent unilateral inguinal herniorrhaphy were enrolled. Four patients were excluded, and the remaining were allocated to the control group and the TFP block group. In the TFP block group, 0.4 ml/kg bupivacaine 0.25% was instilled in the plane between the transversus abdominis and transversalis fascia, while in the control group 0.9% saline was used instead of bupivacaine. The collected data were the total dose of paracetamol consumed during the first 12 h postoperatively, the postoperative Face, Leg, Activity, Cry, Consolability (FLACC) pain score, time to first use of rescue analgesia, number of patients required additional postoperative analgesics, and parents' satisfaction.ResultsThe median paracetamol consumption was significantly lower in the TFP block group than in the control group, and FLACC pain scores were significantly lower for all study times in the TFP block group with higher parental satisfaction scores than those for the control group. The number of patients who required additional analgesics was significantly lower in the TFP block group than in the control group. ConclusionsThe use of a TFP block decreases postoperative analgesic consumption and postoperative pain intensity after pediatric inguinal herniorrhaphy. Future studies with larger sample size are required to evaluate the actual complications rate of TFP block.

Prevalence and Pattern of Birth Defects among Pediatric Surgical Patients: A 12-Year Analysis in a Tertiary-level Government Hospital in Bangladesh

Aims: Birth defects are structural or functional abnormalities which occur during the intrauterine life but can be identified at birth or a later age. Birth defects are major public health concerns and the World Health organization (WHO) is supporting countries for earlier diagnosis and better treatment of these conditions. The aim of the study was to assess the hospital-based prevalence and types of birth defects among the surgical children from a part of the world where these are underreported.
 Materials and Methods: We retrospectively analyzed patients of birth defects admitted in the Department of Pediatric Surgery, Chattogram Medical College Hospital, Bangladesh for a period of 12 years (2008-2019). Data were extracted from annual admission reports, annual audits, mortality and morbidity audits, death registers and computerize data base. Yearly distribution of birth defects, type of defects and their systemic distribution and mortality were analyzed.
 Results: Among a total of 30,301 admitted patients 30.72% (9307 patients) had birth defects. The most common system involved with birth defects was gastrointestinal (GI) system, 30.61% followed by genitourinary (GU), 29.15% system. Congenital inguinal hernia (17.50%) was the most common disease, followed by hypospadias (14.54%) and anorectal malformation (ARM); 13.98%. Mortality from birth defects were 53.25% of all mortalities. ARM was the most common cause of death (23%), followed by gastroschisis (16%) and intestinal atresia (11%). Highest mortality rates were in tracheo-esophageal fistula/esophageal atresia (TEF/EA)- 83.33%, gastroschisis-80.92%; intestinal atresia-42.53%; omphalocele-32.48%; and congenital diaphragmatic hernia (CDH)- 27.78%.
 Conclusion: Pattern of birth defects and outcome varied from other countries. The prevalence is 31% among pediatric surgical admissions. Some conditions have extremely high mortality rates and need better management.

Клиническая анатомия, типы косых врожденных паховых грыж и особенности их лапароскопической герниорафии

Клиническая анатомия, типы косых врожденных паховых грыж и особенности их лапароскопической герниорафии

CRITERIA OF EFFICIENCY OF INGUINAL HERNIOTOMY IN CHILDREN UNDER VARIOUS TECHNIQUES

Purpose. To improve outcomes of congenital inguinal hernia treatment in children by improving a technique of extracorporal herniorrhaphy and by ligature guide modification. Outcomes after surgeries performed with different techniques were assessed by the level of postoperative pain and by the quality of life. Material and methods. Outcomes were analyzed in 60 children operated on for inguinal hernia with 3 different approaches: Duhamel, LASSO, LOD . The intensity of postoperative pain syndrome was assessed 4 hours after surgery and on the next postoperative day. The quality of life was assessed in 24 patients out of 60 on the next postoperative day. Results. The analysis on distribution to normality for postoperative pain did not reveal any statistical differences on sex, age and diagnosis. Boys (average age 69.6 - 84 months) prevailed. In 4 hours after the surgery, patients who had laparoscopic intervention had less number of scores in comparison to those who had open herniorrhaphy. There were no difference in laparoscopic groups. On the next postoperative day, pain syndrome in all groups was about the same. The quality of life in patients differed only by their physical status and by the total number of scores; and these parameters were higher in LOD group (32.8 scores versus 89.4 scores). Conclusion. A modified LOD technique improves the quality of life in operated patients. Four hours after laparoscopic herniorrhaphy, a pain syndrome is less pronounced.

Ectopic testis: an experience of a tertiary-level urology center at Upper Egypt

BackgroundTesticular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center’s experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001–June 2016.ResultsOut of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. The other ectopic 21 cases (mean age = 10.56 ± 6.92 years) were perineal, anterior abdominal wall, femoral, prepubic, and transverse testes in 7 (33.3%), 4 (19%), 4 (19%), 3 (14.3%), and 3 (14.3%) cases, respectively. Congenital inguinal hernia was the commonest associated anomaly (22.7%). All cases were treated surgically with only 1 case of testicular atrophy (2.3%).ConclusionsTesticular ectopia is rare with relatively delayed presentations. Different anatomical sites have been reported including the superficial inguinal pouch and anterior abdominal wall with variable complexities and controversies. The inguinal ectopic testis is the most controversial, but it might be characterized from other entities based on certain clinical and surgical criteria.

Transverse testicular ectopia with M\xfcllerian duct remnant in an incarcerated congenital inguinal hernia \u2013 a case report

BackgroundTransverse testicular ectopia (TTE) is a rare anomaly characterized by both testes descending through a single inguinal canal. In this report, the diagnosis of TTE was discovered in the event of an incarcerated congenital inguinal hernia in a neonate.Case presentationWe present a case of TTE accompanied by persistent Müllerian duct structures (PMDS) that had been discovered incidentally during inguinal exploration of a 26-day-old boy who presented with an incarcerated congenital inguinal hernia on the right side and left cryptochidism on the left side. The pathogenesis, approach and proposed management of TTE are discussed.ConclusionTTE is an extremely rare anomaly, especially in neonates, and should be suspected in patients presenting with inguinal hernia on one side and cryptorchidism on the other side.

Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report

BackgroundTeriparatide is a homolog of human parathyroid hormone (1–34), which is approved for the treatment of postmenopausal and glucocorticoid-induced osteoporosis. Several minor and transient side effects have been reported for teriparatide. However, controversial findings showed an increased risk of more significant adverse effects, including osteosarcoma in humans, although this finding has been demonstrated primarily in murine models.Case presentationWe present a case of a 22-year-old Persian man with a previous history of systemic lupus erythematosus and glucocorticoid-induced osteoporosis. He had a previous history of joint hypermobility, idiopathic kyphoscoliosis, mitral valve prolapse, and bilateral congenital inguinal hernia, which were probably compatible with an inherited connective tissue disease. He was treated with teriparatide for 7 months because of glucocorticoid-induced osteoporosis. He was referred with a complaint of generalized bone pain and an extremely elevated serum alkaline phosphatase concentration of 6480 U/L (normal range, 80–306). A whole-body bone scan revealed a diffuse increased osseous uptake. Furthermore, the patient’s systemic lupus erythematosus was clinically inactive on the basis of laboratory findings during this period. The medication was discontinued, and the patient’s serum alkaline phosphatase level began to decline.ConclusionsTo the best of our knowledge, this is the first case of an osteoblast hyperactivation state observed during treatment with teriparatide. It appears that the osteoblastogenic effect of teriparatide might induce this condition and, most likely, osteosarcoma in certain populations. However, the potential influence of the patient’s young age, systemic lupus erythematosus, underlying inherited connective tissue disease, and medication use cannot be ignored. The potential risk factors of this side effect shall be studied in specific subpopulations of patients with osteoporosis in future studies.

Laparoscopic assisted percutaneous internal ring suturing for inguinal hernia repair in pediatrics

Several laparoscopic techniques used in treatment of pediatric inguinal hernia differ in their approach to the internal inguinal ring, suturing and knotting techniques, number of ports, endoscopic instruments used and hernia sac dissection technique. The aim of this study was to evaluate efficacy and safety of laparoscopic assisted percutaneous internal ring suturing for inguinal hernia repair in pediatrics. Laparoscopic assisted percutaneous internal ring suturing was performed under general endotracheal anesthesia on 54 children with 64 hernias during the period from July 2018 to June 2019. Under laparoscopic-guided vision a 2-0 Prolene® thread inside an 18-gauge epidural needle was placed through the abdominal wall into the peritoneal cavity, then the thread passed under the peritoneum around the internal ring. The knot was tightened from outside and placed in the subcutaneous space. The mean operative time was 14.18 min for unilateral and 21.2 min for bilateral hernias. Cosmetic results are excellent with almost invisible scars. There were no intraoperative and six postoperative complications (recurrence in three cases, transient hydroceles in two boys and one patient had stitch sinus). Laparoscopic assisted percutaneous needle repair of congenital inguinal hernia seems to be a simple minimally invasive procedure in small ring diameter with excellent cosmetic results. But I do not recommend this technique due to high rate of complications and recurrence, also simplicity of the technique can be regarded as a hindrance to the surgeons in training from challenging their skills to be ready for the more complex scenarios.

Laparoscopic repair of congenital inguinal hernia: a comparative study between purse–string suture and peritoneal disconnection with ligation techniques in bilateral cases

Many laparoscopic surgical techniques were described for management of inguinal hernia in pediatric patients. This prospective study was conducted to compare laparoscopic purse–string suture of hernia sac at the internal ring at one side, leaving the distal sac intact (technique I) and disconnection of the hernia sac with intra-corporeal suture of proximal part at the internal ring (technique II) in the other side in the same case. Thirty three patients with bilateral congenital inguinal hernia (66 repairs) were included in this study. The outcome variables were operative time, intraoperative complications, post-operative complications and recurrence rate. This study included 28 males and 5 females. The age of the patients ranged from 1 to 72 month with a mean of (15.27 ± 19.09). The operative time was shorter in technique I than in technique II and this difference was statistically significant. No intraoperative complications were reported. Five cases (15%) developed hydrocele and two cases (6%) developed recurrence in technique I during the follow up period. Laparoscopic repair of congenital inguinal hernia using laparoscopic disconnection of the sac and closure of the internal ring has lower recurrence rate and hydrocele formation but longer operative time compared to laparoscopic purse–string closure alone. Due to the high rate of recurrence in technique I, there is definite superiority of technique II as a surgical option.

Congenital inguinal hernia repair with and without opening the inguinal canal

Abstract Background Elective repair of congenital inguinal hernia is the most common surgery performed by pediatric surgeons and is considered the treatment of choice. The exact technique and steps involved in the repair differs widely among pediatric surgeons, many surgeons open the roof of inguinal canal while preserving the external ring or opening it, this is called the modified Ferguson, s technique. In infants, the inguinal canal is short and virtually the internal and external rings lie over each other so many surgeons also like to perform the whole operation without opening the external oblique aponeurosis distal to the external ring, this technique is called the Mitchell Banks technique. Objective To compare both techniques regarding intraoperative time, incidence of intraoperative and postoperative complications to pass our experience in a trial to reach an ideal surgical technique for congenital inguinal hernia repair. Patients and Methods In this study, 60 cases of congenital inguinal hernia were randomly selected and divided into two equal groups where group A underwent the repair with opening the external oblique aponeurosis and group B underwent the repair without opening the external oblique aponeurosis. Results As regard the postoperative complications, the patients who underwent the Ferguson’s technique experienced more postoperative pain with statistically significant more incidence of postoperative hydrocele than the Mitchell banks technique, no complications occurred postoperatively other than hydrocele in our study. Conclusion Our study results, we can approve that Mitchell Banks technique is easier, consumes less time than Ferguson’s technique with less incidence of postoperative complications and pain which can make this technique better for congenital inguinal hernia repair in children aging 2 years or less.

Bile Stained Vomiting in Neonates: Radiological and Surgical Correlation

Abstract Background: Bile stained vomiting in neonates is fre-quently encountered clinical symptom in pediatric practice. It is very important to examine them and exclude or confirm surgical condition. Aim of Study: This work is advocated to illustrate the spectrum of radiological findings in neonates with bile stained vomiting and correlate them with surgical data. Patients and Methods: All included neonates presented with bile stained vomiting were referred to Diagnostic Radi-ology Department at Sohag University Hospitals. Abdominal X-ray, abdominal ultrasound, Doppler and contrast imaging were done to identify the surgical causes of bilious vomiting with clinical and surgical correlation. The patients were treated surgically in Pediatric Surgery Unit at Sohag University Hospitals. Patients with bilious vomiting caused by non-surgical causes were excluded. Results: Our study included 31 bile stained vomiting neonates with age range from one day to 30 days and with male sex predominance (17 boys and 14 girls). Four patients were found to have necrotizing enterocolitis, 5 cases with mid-gut volvulus, 3 cases were found to have distal duodenal atresia, one case with duodenal stenosis, 5 cases with jejunal atresia, 4 cases with ileal atresia, 2 cases with congenital bands, 2 cases with complicated congenital inguinal hernias, 2 cases with meconium plug, 1 case with neonatal intussus-ception, 1 case with iatrogenic clamping of umbilical hernia and 1 case with anal stenosis. Imaging techniques were diagnostic in most of the cases and correlate with surgical findings. Conclusion: Bile stained vomiting in the newborn usually indicative of surgical conditions and needs surgical consulta-tion. Imaging studies are of utmost important to investigate and diagnose these cases before surgery.

A Modified Approach for Single-Port Laparoscopic Repair of Inguinal Hernias in Children.

Background:Although traditional open groin incision repair has been used routinely for decades, the benefit of the minimally invasive surgery has challenged the traditional open method. Nowadays, laparoscopic herniorraphy has evolved to making it more minimally invasive from 3 to 2 and now single port and from intracorporeal to extracorporeal knotting. This study aimed to evaluate a new modification of single port laparoscopic herniorraphy in children with congenital inguinal hernia.Materials and Methods:In this single-institution randomized case–control study 190 children who suffered from congenital inguinal hernia were divided into two groups randomly: Group 1 (N = 73) undergone a single-port modified extracorporeal purse-string sutures (laparoscopic surgery [LS]) and Group 2 (N = 117) undergone open surgery (OS).Results:The mean age of the patients at operation time was 28.79 ± 11.45 months. Overall, three patients (1.57%) had intraoperative retroperitoneal hemorrhage. The duration of anesthesia and operation for those undergoing bilateral operation were significantly shorter in LS group. There was no statistically significant difference in individual postoperative complication rates between the groups. The proportion of overall post-operative complications was 4 (5.4%) in LS and 13 (11.1%) in OS group (P = 0.18). Proportion of trapped cryptorchidism was significantly higher in the OS group.Conclusion:In conclusion for children with inguinal hernia, we had found the benefits of single-port modified extracorporeal purse-string for reduction the operative time, trapped testes and better cosmetics and parents' satisfaction.

Case report of 49, XXXXY syndrome: first case in Oman

Background: The incidence of sex chromosome aneuploidies is 1:400. Klinefelter syndrome is considered to be the most common type of sex chromosome aneuploidy, manifested as variants, such as 48,XXXY, 48,XXYY and 49,XXXXY. Nondisjunction of the X chromosome during meiosis I and II is considered as the cause of this type of aneuploidy. The classic clinical presentation of Klinefelter Syndrome is a triad of hypogonadism, mental retardation, and musculoskeletal anomalies. Case Presentation: In this case report, we describe a 2-year-old male child identified postnatally to have low birth weight, congenital heart defect, inguinal hernia, facial dysmorphism, and genital organs anomalies. Chromosomal analysis revealed a karyotype of 49,XXXXY and the comparative genomic hybridization (CGH) array analysis revealed a 155,065 kilo base pair duplication on chromosome Xp22.33q28 (168,546, −155,233,731) X4. Conclusion: 49,XXXXY karyotype is considered as the rarest sex chromosome aneuploidy syndrome. To our knowledge, this study is the first report of a patient with 49,XXXXY syndrome from Oman.

Congenital inguinal hernia in children in the structure of «short stay» technologies in pediatric surgery

The surgery of one day allows to reduce risk of a negative consequence of hospitalization for the child. Purpose of the study. The analysis of results of treatment of children with inguinal hernia by the principle of the «short stay» technologies. Materials and methods. 629 cases of expeditious treatment of children with inguinal hernia are analysed. Results. The average duration of operation, from a section to a final seam, at unilateral hernia was 20,9 ± 3 minutes, at bilateral 32,3 ± 2 min. Statement of an additional trocar at a certain type of an internal abdominal ring allowed to reduce operation duration. Conclusion. Introduction in clinical practice of modern forms of inpatient replacing technologies allows to increase efficiency of treatment of children with congenital inguinal hernia.

Laparoscopic Needle assisted Repair of Inguinal Hernia in Children in Manipal Teaching Hospital, Pokhara

Introduction: There are numerous minimally invasive surgical techniques for repair of congenital inguinal hernia (CIH) in children. We present a unique needle-assisted laparoscopic inguinal hernia repair using 20-gauge intravenous cannula. This study aims to evaluate the safety and feasibility of this technique.
 Methods: This prospective descriptive study was conducted in 50 patients; aged 1-13 years; from February 2018 to May 2019; either admitted with the diagnosis of CIH or detected incidentally when operated for some other surgical conditions. CIH was repaired using single supraumbilical port and 2-0 prolene suture passed through 20-gauge intravenous cannula. Statistical analysis was done using SPSS 20.
 Results: A total of 56 hernias were repaired in 50 patients out of which five cases were detected incidentally on patients undergoing laparoscopic appendectomy. The bilateral CIH was present in six cases. The mean operative time was 18.20 ± 4.57 minutes; 17.36 ± 3.83 minutes for unilateral hernia and 24.33 ± 5.20 minutes for bilateral hernia. There was no difference in operative time when compared between gender (p=0.26). The complications were recurrence in 1(1.78%) case, hematoma around deep ring in 2 (3.57%) cases and puncture site bleeding in 2 (3.57%) cases. There were 35 (70%) male and 15 (30%) female. The contralateral occult hernias were noted in 5 (10%) cases.
 Conclusions: Single port laparoscopic repair of inguinal hernia using a 20-gauge intravenous cannula with non-absorbable suture is a safe, effective and feasible in resource poor settings. The postoperative complications are minimal which is similar to past studies.