Comparison Between Inguinal Herniotomies With and Without Incising External Oblique Aponeurosis: A Randomized Clinical Trial

Abstract

Background:Inguinal herniotomy is the most common surgery performed by pediatric surgeons. Aim:To compare the results and complications between two conventional methods of pediatric inguinal herniotomy with and without incising external oblique aponeurosis in terms of recurrence of hernia and other complications. Methods: This one blinded clinical trial study was conducted on 800 patients with indirect inguinal hernia. Inclusion criterion was children with inguinal hernia. The first group underwent herniotomy without incising external oblique aponeurosis and second group herniotomy with incising external oblique aponeurosis. Recurrence of hernia and other complications including ileoinguinal nerve damage, hematoma, testicular atrophy, hydrocele, ischemic orchitis, and testicular ascent were evaluated. Results:Recurrence and other complications with or without incising external oblique aponeurosis had no significant difference, exception made to hydrocele significantly differed between the two groups, higher in the incision group.Conclusion:Herniotomy without incising oblique aponeurosis can be appropriate choice and better than herniotomy with incising oblique aponeurosis. Children with inguinal herniotomy can be benefit without incising oblique aponeurosis, instead of more interventional traditional method.

A Meta-Analysis on the Comparison Between Pediatric Inguinal Herniotomies Performed With and Without Incising the External Oblique Aponeurosis in Terms of Recurrence and Complications

“…5 According to a survey among North American pediatric surgeons conducted by Levitt, et al (2002), the Mitchell-Banks technique had been used safely in children aged up to 11 years, with a recurrence rate similar to the Ferguson technique. 6 In support of this, the study of Askarpour (2017) divided subjects into age subgroups as follows: less than 3 months, 3 months to 2 years, 3 to 5 years, and 6 to 12 years. Subjects per age subgroup were equally distributed between the Mitchell Banks and Ferguson techniques.…”

“…1 In a clinical trial by Askarpour, et al there was no significant difference in the rate of recurrence and complications between the two herniotomy techniques, with exception made to the incidence of post-operative hydrocele, which was significantly higher in the technique where the external oblique aponeurosis was opened. 2 The authors wanted to know if there was a significant difference between pediatric inguinal herniotomies performed with and without incising the external oblique aponeurosis in terms of hernia recurrence and post-operative complications.…”

Estudo comparativo entre a técnica de lichtenstein e a técnica videolaparoscópica na abordagem terapêutica de hérnia inguinal, tendo por escopo a avaliação da frequência de recidivas e complicações

“…Dentre estas, podemos destacar as técnicas laparoscópicas, que ainda são vistas como operações complexas, mesmo por cirurgiões mais experientes (8). Embora tenha sido descrita pela primeira vez na década de 1990, o reparo laparoscópico inguinal ainda encontra resistência entre os cirurgiões (9)(10)(11), uma vez que o reparo aberto é menos oneroso e mais fácil de aprender (12)(13)(14)(15).…”

Systemization of Laparoscopic Inguinal Hernia Repair (Tapp) Based on a New Anatomical Concept: Inverted Y and Five Triangles

“…Repair of inguinal hernias is one of the most common procedures performed by general surgeons around the world 4 , 24 . Although first described in the 1990s, laparoscopic inguinal repair still finds resistance among surgeons today 2 , 7 , 23 . Main reasons are higher direct cost, need for general anesthesia and eventual higher rate of major complications associated with laparoscopic repairs 17 , 22 .…”