Patent Processus Research Articles

Triple Trouble: Acute Appendicitis with Right Testicular Torsion and Concurrent Right Inguinoscrotal Hernia- A Case Report

Acute appendicitis commonly presents with right iliac fossa pain. However, it may present with right scrotal pain and swelling, which may be confused with other scrotal pathologies such as orchitis, scrotal abscess, and testicular torsion. Acute appendicitis in children and adolescents may present with scrotal pain due to inflammatory intraperitoneal fluid tracking down into the scrotal sac via a patent processus vaginalis. In rare cases, acute appendicitis may present concurrently with testicular torsion, making the diagnosis much more challenging. Herein, we present an even rarer case of acute appendicitis with right testicular torsion and concurrent right inguinoscrotal hernia.

Comparative Analysis of Inguinoscrotal Orchidopexy With and Without Formal Patent Processus Vaginalis Ligation in Pediatric Patients: A Matched Cohort Study

Comparative Analysis of Inguinoscrotal Orchidopexy With and Without Formal Patent Processus Vaginalis Ligation in Pediatric Patients: A Matched Cohort Study

Orchidopexy for undescended testis—rate and predictors of re-ascent

PurposeThis study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent.MethodsA retrospective cohort study of children treated for undescended testis (UDT) with orchidopexy between 2018 and 2022 was conducted. The primary outcome was re-ascent requiring re-operation, and the secondary outcome was atrophy rate. Independent variables were age, underlying conditions, side, surgical approach, operation time, bilaterality, congenital/ascended UDT, presence of scrotal hypoplasia, presence of a patent processus vaginalis, division of external oblique, and suture of the testis. Univariate and logistic regression were used to evaluate differences between groups and risk for re-ascent.ResultsA total of 662 testes in 554 patients were included. Re-operation occurred in 6% (7% with inguinal approach, 3% with scrotal approach, p = 0.04). Re-operation was associated with younger age, congenital UDT, and inguinal approach, but neither of these variables remained significant in multivariate analyses. Atrophy occurred in one testis.ConclusionThe rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias.

Comparison of Percutaneous Internal Ring Suturing (PIRS) versus Open Ligation of the Patent Processus Vaginalis for the Treatment of Communicating Pediatric Hydrocele.

Although the laparoscopic approach become standard for the treatment of many surgical conditions many studies still debating whether laparoscopic surgery has significant advantages over open surgery in regards to hernia or hydrocele treatment. This study aimed to evaluate the outcomes of treatment of treatment of communicating hydrocele in pediatric patients between laparoscopic percutaneous internal ring suturing (PIRS) and open ligation of the patent processus vaginalis (PPV). The medical records of pediatric patients who underwent surgery for communicating hydrocele between 1 January 2019 and 1 January 2024 were retrospectively reviewed. The primary objective of the study is to investigate the outcomes of treatment (complications and recurrence rates) of communicating hydrocele in children between laparoscopic and open surgical approaches. Secondary outcomes of the study are the duration of surgery and anesthesia, length of hospital stay (LOS), frequency of hospital readmissions (ReAd) and unplanned return to the operating room (uROR). A total of 198 children underwent surgery for a communicating hydrocele (205 repairs, as 7 cases were bilateral) and were included in the study. Of these, 87 children underwent a PIRS, while the remaining 111 cases underwent open ligation of the PPV. No recurrence of the hydrocele was observed in any of the study groups. Intraoperative complication (epigastric vein injury) was noted in two cases in both groups (2.3% vs. 1.8%, p > 0.999). A slightly higher number of postoperative complications was observed in the open group (n = 7, 6.3%) compared to the PIRS group (n = 2, 2.3%) (p = 0.190). The median duration of surgery (15 min (IQR 10, 17) vs. 21 min (IQR 15, 25); p < 0.001) and anesthesia (30 min (IQR 25, 40) vs. 40 min (IQR 35, 40); p < 0.001) were significantly lower in the PIRS group compared to open ligation of the PPV. In addition, a significantly shorter median of LOS was observed in the PIRS group compared to the open PPV group (9 h (IQR 8, 12) vs. 24 h (IQR 12, 24; p < 0.001). No cases of ReAd and uROR were observed in any of the study groups. PIRS is a safe and effective laparoscopic technique that can be used in the treatment of communicating hydrocele in children. PIRS showed excellent outcomes and a low incidence of complications and recurrences, comparable to traditional open surgery.

Scrotal Migration of The Distal End of The Ventriculoperitoneal Shunt: Is There a Role for Early Closure of Patent Processus Vaginalis in The Pediatric Population?

Background: Ventriculoperitoneal shunt (VP) insertion is one of the surgical treatments for patients with hydrocephalus. Infection, malfunction, catheter migration, hernia development, equipment failure, CSF subcutaneous collection and peritoneal pseudocyst formation are considered to be the main complications of this procedure. Case Description: A 6-months-old boy known to have congenital aqueductal stenosis with VP shunt insertion at the age of 1 month, presented with scrotal swelling and generalized hypotonia. He was found to have catheter migration into the scrotum. Conclusion: Scrotal migration of the distal end of the ventriculoperitoneal shunt is a rare but threatening complication that can present with either signs of hydrocephalus or scrotal swelling or hydrocele. Accordingly, we recommend performing a scrotal exam with an ultrasound early upon evaluation of any infant presenting with scrotal swelling or hydrocele after VP shunt insertion. There haven’t been clear recommendations in the literature concerning closure of patent processus vaginalis upon placing a VP shunt in patients below the age of 3 months. Thus, we question whether early closure could help reduce the complications of catheter migration in infants.

Laparoscopic-Assisted Scrotal Approach for the Treatment of Inguinal Cryptorchidism with Patent Processus Vaginalis: Clinical Efficacy Analysis.

Objective: This study aimed to compare the clinical outcomes of two surgical approaches, laparoscopic-assisted scrotal incision and conventional inguinal-scrotal incision, for treating cryptorchidism with unobliterated processus vaginalis. Methods: Clinical data from 60 pediatric patients with inguinal cryptorchidism who were admitted to our institution between January 2018 and January 2022 were retrospectively analyzed. Depending on the surgical technique used, the patients were split into two groups: the laparoscopic group (n = 30) underwent a laparoscopic-assisted scrotal incision, whereas the conventional group (n = 30) underwent a conventional inguinal-scrotal incision for testicular descent and fixation. The length of the procedure, intraoperative blood loss, and the typical hospital stay following the procedure were compared between the two groups. Also assessed was the frequency of postoperative complications including wound infection and hematoma development. Results: The laparoscopic group demonstrated a notably shortened average surgical duration compared with the traditional group, and this discrepancy held statistical significance (P = .017). Moreover, the laparoscopic approach resulted in a reduced volume of intraoperative blood loss, with a statistically significant distinction (P = .002), along with a decreased average length of hospital stay after surgery, also statistically significant (P = .009). Testicular retraction, atrophy, inguinal hernias, or hydrocele were not present in any group. Although the difference between the laparoscopic and open groups was not statistically significant (P > .05), the laparoscopic group saw a reduced frequency of scrotal hematoma. The frequency of wound infection was also decreased in the laparoscopic group compared with the open group, although there was no statistically significant difference (P > .05). Conclusion: The laparoscopic-assisted scrotal incision approach for testicular descent and fixation offers precise localization of cryptorchidism, reduced surgical trauma, shorter postoperative recovery time, and results in smaller scars with minimal tissue damage. The procedure showcases enhanced overall clinical effectiveness, fewer postoperative complications, heightened safety, and superior cosmetic outcomes.

Treatment of Patent Processus Vaginalis During Umbilical Hernia Repair in Children

Froehlich, Mary MD; Chang, Shirong MD, FACS; Scheidler, Michael G MD, FACS Author Information

Analysis of Contralateral Patent Processus Vaginalis in Laparoscopic High Ligation of the Vaginal Process and Clinical Long-term Effect of Individualized Treatment

Background: We aimed to analyze contralateral patent processus vaginalis (CPPV) in the laparoscopic high ligation of the vaginal process, treat eligible children surgically, and evaluate the clinical long-term outcomes. Methods: A total of 300 children with unilateral inguinal hernia or unilateral hydrocele treated in our hospital were selected for laparoscopic high ligation of the vaginal process, during which CPPV was analyzed. The 300 children were randomly divided into two groups of 150. In the study group (n = 58), 11 children met the requirements of high ligation and were treated with simultaneous surgery. The 53 children in the control group received simultaneous treatment. The prevalence of CPPV was compared between children with unilateral indirect inguinal hernia and unilateral hydrocele, left and right patent processus vaginalis (PPV), and different ages. After surgery, both groups were followed up for one year. The recurrence rate of contralateral indirect inguinal hernia or hydrocele was compared. Significant differences were assessed between the two groups receiving different treatments. Results: The prevalence of CPPV was 23% in children with unilateral indirect inguinal hernia and 49% in children with unilateral hydrocele. The prevalence of CPPV in children with unilateral hydrocele was significantly higher than that in children with inguinal hernia (P = 0.00). The prevalence of CPPV was 42% in children with left PPV and 33% in children with right PPV, without a statistically significant difference (P = 0.19). The prevalence of CPPV was 63% in children aged 1 - 2 years, which was significantly higher than that in other age groups (χ2 = 7.46, P = 0.01). The prevalence of CPPV was 14% in children aged &gt; 6 years, which was significantly lower than that in other age groups (χ2 = 4.43, P = 0.04). A postoperative one-year follow-up showed that the recurrence rate was 9% in the study group and 1% in the control group, without a statistically significant difference (P = 0.25). Conclusions: The prevalence of CPPV decreases with age. Hydrocele combined with CPPV is more common. For younger children with hydrocele, it is very important to explore the contralateral side during surgery. Moreover, the transformation of CPPV to indirect inguinal hernia or hydrocele occurs rarely, and only eligible children can receive simultaneous treatment during surgery.

Cyst of the canal of Nuck in an adult female

Background: A female hydrocele is an extremely rare complication of a patent processus vaginalis. A cyst of the canal of the Nuck should be considered in females presented with a non-reducible groin mass. Case Presentation: A 38-year-old female presented to the clinic with a nontender palpable mass in the right inguinal region. On physical examination, a soft-consistency, mobile mass of about 6 cm in size was seen in the right inguinal region. The cyst was seen to be originating from the external ring. Surgical exploration was carried out by an incision in the right inguinal area and the cyst was dissected from the round ligament. The defect was repaired with prolene mesh after high ligation. Histopathologic examination confirmed the diagnosis of a cyst of the canal of Nuck. Discussion: The canal of Nuck extends through the inguinal canal alongside the round ligament and is considered the female analog of the processus vaginalis in males. A cyst of the canal of Nuck is a rare occurrence and can be classified into three types based on its communication with the peritoneal cavity. The mainstay of treatment of cyst of the canal of Nuck is surgical excision. Ligation of the processus vaginalis after excision is believed to prevent a recurrence. Conclusion: A swelling in the inguinal region in females should raise the suspicion of a cyst of the canal of the Nuck and be considered in the differential diagnosis.

Benefits of Contralateral Patent Processus Vaginalis Closure During Laparoscopic Surgery for Inguinal Hernia in Female Children.

After more than a decade, an accurate description of the current state of pediatric inguinal hernia repair still an issue of contention. Improvement of techniques together with patient-entered intervention that account for the experiences related to individual disease characteristics have become an important factor of which the surgeon must be aware. Therefore, the aim of this study is to analyze a potential treatment for metachronous contralateral inguinal hernia (MCIH) in children during laparoscopic assisted percutaneous internal inguinal ring suturing (PIRS). In a prospective clinical study, carried out at the University Clinic for Pediatric Surgery in Skopje, Republic of North Macedonia, we analyzed the data from 49 female children, aged 1-14 years old, with clinically diagnosed congenital inguinal hernia treated via PIRS. The position of hernias on the right side was 29 (59.2%) on the left side was 19 (38.8%) and on both sides was 1 (2.0%). With intraoperative assessment, it was determined that in 33 (67.3%) participants there was no presence of a hidden hernia, while in 16 (32.7%), there was indeed the presence of a hidden hernia. Of the hidden hernias determined laparoscopically [16 (100%)], 8 (50%) were left and right hidden hernias, all treated laparoscopically. The PIRS technique is a procedure where the basic advanced treatment is exploration. This also included the adequate treatment of other pathologies, such as the prophylactic closure of a contralateral patent processus vaginalis with simultaneous treatment as there is the potential for hernia in future, therefore reducing the number of metachronous inguinal hernias.

Intraperitoneal abscess from perforated diverticulitis with fistualization to extraperitoneal abscess into the scrotum: a case report

BackgroundScrotal abscesses are common skin abscesses seen in the general population; however, intraperitoneal abscesses tracking into the scrotum are rare. Intraperitoneal and retroperitoneal abscesses contiguous with the scrotum have been reported in the literature in specific populations. Wound cultures can aid in differentiating the source of the infections. Recurrent abscesses have been observed in high-risk populations, such as those with malignancy or who are immunocompromised.Case presentationWe present a 71-year-old male with pericolonic abscess following perforated diverticulitis. The abscess was drained with interventional radiology and was complicated by an extraperitoneal abscess that tracked to the scrotum. Incision and drainage of the extraperitoneal abscess and the scrotal abscess were required with intravenous antibiotic therapy. The abscess tracking into the scrotum is reported without evidence of patent processus vaginalis.ConclusionWe conclude that an intraperitoneal abscess can track to the scrotum through extraperitoneal fascial planes in the absence of a patent processus vaginalis. We show that extraperitoneal abscess spread to the scrotum is possible, with wound cultures helping to differentiate the source of the infection. High-risk patients with recurrent abscesses can also be susceptible to contiguous spread.

Profile of Contralateral Patent Processus Vaginali in Pediatric Patients with Unilateral Inguinal Hernia

Objective: Reporting the incidence of contralateral patent processus vaginali (CPPV) in pediatric patientswith unilateral inguinal hernia. Methods: The study was conducted from November 2010 - February2012. Patient’s identity were recorded for registration number, name, age, gender, address and date ofexamination. The surgery was conducted by a trainee pediatric surgeon as a researcher and resident. Highligation procedure and diagnostic of contralateral PPV. Results: This study included 40 pediatric patients ofvarious ages diagnosed with lateral inguinal hernia. There were 31 male patients (77.5%), 24 patients (60%)with right inguinal hernia patients, and 14 patients (35%) aged 0-1 years. Conclusion: The transinguinallaparoscopic contralateral PPV technique is helpful in diagnosing the presence of contralateral PPV. Theincidence of contralateral PPV in this study was 27.5%. Furthermore, early age increased the incidence ofcontralateral PPV.

Development and current status of treatment for pediatric indirect inguinal hernia

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.

Modified percutaneous internal ring suturing with peritoneal injury in children: matched comparison to open hernia repair.

The aim of this study was to elucidate the outcomes of percutaneous internal ring suture (PIRS) technique for inguinal hernia repair augmented with thermal peritoneal injury compared to open inguinal hernia repair (OHR) in a large population of contemporary pediatric patients. Thermal injury with PIRS has been shown to reduce recurrence in animal models and is increasingly being incorporated into clinical practice. Retrospective review of all PIRS procedures and OHR between Jan-2017 to Sept-2018 was performed. Data regarding patient characteristics, characteristics of the hernia, operative details, postoperative complications, and recurrence were collected. Non-parametric tests were used and p < 0.05 was regarded as statistically significant. 1:1 Propensity score matching was performed using "nearest-score" technique. Matching was done based on age, sex, follow-up time, side of hernia, repair of contralateral hernia, and number of additional procedures. 90 modified PIRS patients were matched to 90 OHRs. Patient demographics, hernia characteristics, and follow-up time were similar between the two groups after matching. There were no differences in recurrence rates (1 vs. 3 in OHR and PIRS, respectively, p = 0.6), complication rates (1 vs. 4 in OHR and PIRS, respectively, p = 0.4), and OR time [44.5 vs. 43min in OHR and PIRS, respectively, p = 0.8]. There were no intraoperative complications for either technique. For OHR, laparoscopic look was performed in 23%. When successful, it revealed a contralateral PPV (patent processus vaginalis-PPV) in 41% of cases (9.4% of all OHR), all of which were repaired. For the PIRS procedures, a contralateral PPV was found in 25.6%, all of which were repaired. In the unmatched population, OHR had a metachronous hernia rate of 1.8%, none of whom had the contralateral PPV repaired at the original procedure. PIRS with peritoneal injury has comparable efficacy and good safety compared to OHR. Recurrence and complication rates should further improve with increasing experience. Future studies should elucidate long term outcomes.

A rare cause of inguinal region swelling and pain in women: Hydrocele of the canal of Nuck

The most common diagnoses of pelvic/supra-pubic pain are related to uterine, gonadal, renal, and bladder complications. Hydrocele of the canal of Nuck is a rare cause of inguinal swelling in women, which occurs due to a patent processus vaginalis. The canal of Nuck typically closes in infancy, however, in some women, the canal of Nuck remains patent, allowing for the development of canal of Nuck cysts or indirect inguinal hernias. Until now, about 400 cases of this illness have been reported worldwide. Clinically, these cysts are usually fluctuant, painless, or may present locally painful masses in the labia or inguinal regions which are not reducible; we report the case of a young female which was characterized by persistent suprapubic pain in which the diagnosis initially made by ultrasonography was further confirmed by contrast-enhanced computed tomography, surgery and pathological examination.

Contralateral processus closure to prevent metachronous inguinal hernia: A systematic review.

Inguinal hernia repair is one of the most frequent operations in pediatric surgery and is increasingly performed laparoscopically. The latter introduced new momentum in the debate on the necessity of contralateral exploration, as the rates of contralateral patent processus vaginales and metachronous inguinal hernias determine whether a routine closure would be overtreatment or useful prevention. We searched MEDLINE via PubMed, Web of Science and Scopus at the 6th of September 2017; reference lists and CrossRef were snowballed for reports citing identified studies. Eligibility criteria were age <18 years, preoperative diagnosis of unilateral hernia, laparoscopic evaluation, and publication since January 2012. Studies using hernioscopy (transinguinal laparoscopy) were excluded. We reported our systematic review following PRISMA criteria. We included 32 reports consisting of 19,188 pediatric patients diagnosed with unilateral inguinal hernia. Of these, 38.5% (95% confidence interval: 34%-43.1%) had a contralateral open processus vaginalis concomitantly found during laparoscopic inguinal hernia repair. A secondary analysis using nine studies that compared open and laparoscopic approaches found that prophylactic closure of contralateral patent processus vaginales resulted in a risk difference of 5.7% (95% confidence interval: 3.6%-7.7%; P < 0.001) following 2691 (42.8%) procedures (nine studies: Ten of 6282 patients operated laparoscopically had a metachronous hernia, versus 286 of 5764 with open hernia repair). Prophylactic closure of a contralateral patent processus vaginalis reduces the number of metachronous inguinal hernias, but about 18 procedures must be performed to prevent one metachronous inguinal hernia, indicating that the indication should be based on personal circumstances of the patient.

Single-Port Laparoscopic Assisted Transcrotal Orchidopexy for Palpable Inguinal Canalicular Cryptorchidism Accompany With Indirect Inguinal Hernia.

Purpose: To assess the outcomes of a novel laparoscopic assisted transcrotal orchidopexy (LATO) combined with percutaneous extraperitoneal closure (PEC) for palpable inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, and evaluate its safety and efficiency.Materials and Methods: A retrospective cohort study for single-port LATO-PEC and traditional inguinal orchidopexy (TIO) was performed between 2011 and 2014. Totally 53 children with both palpable inguinal canalicular testes and indirect inguinal hernia were included. Median patient age was 15month (range, 6 months to 4 years). Of them, 35 patients underwent LATO-PEC procedure, utilizing an umbilical trocar for laparoscope, transcrotal dissection for orchidopexy, and an inner two-hooked cannula for ligation of the patent processus at the level of the internal ring. Three of them were bilateral, 12 on the left side and 20 on the right. Eighteen patients received TIO, seven of them on the left side and 11 on the right. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. Follow-up visits were performed to reassess position and size of the testes.Results: All 56 undescended testes were delivered into the scrotum successfully. In the LATO-PEC group, nine contralateral herniorrhaphy were accomplished simultaneously. Fifteen contralateral patent processus vaginalis (PPVs) in 32 unilateral undescended testis (UDT) were newly confirmed during the laparoscopy, while 6 of them received percutaneous extra-peritoneal herniorrhaphy for visible inguinal bubble in pneumoperitoneum condition. No additional port placement or conversion to open procedure was needed. Mean operative time for unilateral and bilateral LATO-PEC in this study was (37.81 ± 5.23) min and (53.33 ± 2.98) min, respectively. In TIO group, mean operative time was (41.11 ± 8.67) min. There was no statistical difference in operative time between the two approaches for unilateral UDTs (p = 0.098). Median follow-up interval was 24 months (range, 12–84 months). No operative complications were found in either group to date.Conclusions: Singe-port LATO-PEC is a safe, effective, and cosmetic choice for inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, minimizing injuries to the vas deferens and testicular vessels. Laparoscopy can provide a diagnostic and therapeutic solution of contralateral PPV.

Scrotal Hydroceles not associated with Patent Processus Vaginalis in Children

Scrotal Hydroceles not associated with Patent Processus Vaginalis in Children

A Rare Case of Meconium Periorchitis Diagnosed in Utero.

Meconium periorchitis is a rare disorder caused by fetal meconium peritonitis, with subsequent passage of meconium into the scrotum via a patent processus vaginalis. To date, clinical significance of meconium periorchitis for the prenatal diagnosis of meconium peritonitis and prediction for postnatal surgery remains to be determined. We present a clinical course of a fetus presenting with meconium periorchitis induced by meconium peritonitis. At 28 weeks' gestation, fetal ultrasonography indicated fetal ascites associated with bilateral hydrocele and peritesticular calcification without other signs of meconium peritonitis. The pregnancy was uneventful until delivery and the infant was delivered at 37 weeks' gestation. No abdominal distension was observed at birth, and radiography did not reveal any abdominal calcification except for scrotal calcification. Abdominal distension was observed 3 days after birth and laparotomy was performed. The diagnosis of meconium peritonitis was confirmed at surgery. Our case illustrated that careful examination of the scrotum during fetal life was helpful for prenatal diagnosis of meconium peritonitis as well as postnatal management.

A Simple Procedure to Prevent Postoperative Inguinal Hernia after Robot-Assisted Laparoscopic Radical Prostatectomy: A Plugging Method of the Internal Inguinal Floor for Patients with Patent Processus Vaginalis

We introduce a simple procedure to prevent postoperative inguinal hernia after robot-assisted laparoscopic radical prostatectomy. We developed the inguinal hernia prevention procedure based on our prior study. Patent processus vaginalis is an independent predictor of inguinal hernia after robot-assisted laparoscopic radical prostatectomy. We reviewed 74 patients (98 groins) with patent processus vaginalis during robot-assisted laparoscopic radical prostatectomy between May 2007 and April 2013. Of these patients 38 (47 groins) did not undergo the inguinal hernia prevention procedure and 36 (51 groins) were treated with this procedure. For the inguinal hernia prevention the lateral side internal inguinal floor of the patent processus vaginalis was incised and dissected along the spermatic cord. Hemostatic agents were plugged into the end of the dissected canal. After plugging, the internal inguinal floor was closed. We compared the incidence of postoperative inguinal hernia between the 2 groups. Among the 47 groins of the patients who did not undergo the inguinal hernia prevention procedure, postoperative inguinal hernia occurred in 16 groins (34.0%) and developed by a mean of 13.8 ± 8.5 months. In contrast, none of the patients who underwent the inguinal hernia prevention procedure experienced postoperative inguinal hernia during the followup of 11.8 ± 6.2 months. This inguinal hernia prevention procedure required approximately 3 extra minutes. During followup there were no intraoperative or postoperative complications related to the inguinal hernia prevention procedure. Using our simple inguinal hernia prevention procedure, the preventive effect was remarkable. However, studies in a larger patient population with a longer followup should be performed to prove the ultimate clinical impact of this inguinal hernia prevention procedure.