Morbidity after neonatal inguinal herniotomy

Phelps, Simon; Agrawal, Meena

doi:10.1016/s0022-3468(97)90602-3

Cited by 62 publications

(30 citation statements)

References 5 publications

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“…Of these, recurrence is the most frequent and is reported to occur in 0.5-3.8% [4][5][6][7]. The recurrence rate in prematures is known to be higher, ranging from 2.6-8.6% [2,8,9]. The factors that contribute to recurrence have been largely speculative, and have included strangulation, conditions associated with increased intra-abdominal pressure, occurrence of early postoperative complications (infection, haematoma), connective tissue disorders, and the technical skills of the surgeon [5,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Predictors of recurrence after inguinal herniotomy in boys

Vogels

Bruijnen²,

Beasley³

2009

Pediatr Surg Int

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Section: Introductionmentioning

confidence: 99%

Predictors of recurrence after inguinal herniotomy in boys

Vogels

Bruijnen²,

Beasley³

2009

Pediatr Surg Int

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“…Its repair can be challenging, requiring an immaculate technique. A much higher recurrence rate of 9% is reported in this sub-group [3,4].…”

Section: Introductionmentioning

confidence: 52%

“…Moreover, recurrent hernia occurs when this closure does not enclose the sac completely and high intraabdominal pressure (commonly seen in pre-mature infants with concomitant lung disease) forces the small bowel through, in the pursuing days or weeks [4].…”

Section: Discussionmentioning

confidence: 99%

A simplified technique for giant inguinal hernia repair in infants

Banieghbal

2008

Pediatr Surg Int

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Repair of giant inguino-scrotal hernia (GISH) in male infants is a difficult operation, even in experienced hands. It requires an immaculate technique to avoid known complications such as tearing of the sac, injury to delicate testicular vessels and dividing of vas deferens. Moreover, a recurrence rate of 9% is noted in a number of reports. This article describes a new surgical maneuver to simplify the procedure. All GISH repaired by the author, over a 5-year period (October 2001-September 2006), were reviewed retrospectively. In total, 89 infants with 106 GISH underwent uni- or bilateral herniotomies. A standard inguinal incision is made and Scarpa's fascia is sharply opened; the external inguinal ring and the cord is identified. By gentle manipulation and blunt dissection, the spermatic cord together with the testis is exteriorized. The assistant applies gentle traction to the cord, which allows for easy identification of the inguinal sac and its subsequent separation from vas and vessels. Testis is replaced in the scrotum, hernial sac suture ligated at its base and the wound closed in layers. All cases were managed with the above approach. The average length of the procedure was 11 min for unilateral and 19 min for bilateral cases. Except for minimal scrotal swelling post-operatively, no other surgery-related complications were noted during or immediately after the operation. Testicular atrophy or iatrogenic undescended testes were not encountered in the follow-up period. Ipsilateral recurrent hernia was noted in one infant after 6 months which required re-operation with the same technique. In cases of GISH; dislocating the testis into the wound and applying a gentle stretch on the cord allows for a safe dissection of the hernial sac and subsequent herniotomy. This maneuver converts a difficult procedure into a relatively simple one.

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“…Studies were excluded if the number of clinically unilateral hernias that were found to have contralateral abnormalities was unclear. Studies where the primary hernia was only associated with undescended testis were excluded, however three studies where a small proportion of hernias (20%, 1%, and 7% of the cohorts, respectively) [7][8][9] were related to undescended testes were included. Information regarding follow-up, age, sex, and laterality at presentation was recorded where available.…”

Section: Methodsmentioning

confidence: 99%

1619 Evaluation of the Contralateral Inguinal Ring in Clinically Unilateral Inguinal Hernia a Systematic Review and Meta-Analysis

Kokorowski

Wang

Routh³

et al. 2012

Journal of Urology

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Purpose-The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal. (1940-2011) using 'hernia' and 'inguinal' and either 'pediatric,' 'infant,' or 'child,' to identify studies of pediatric (age≤21 yrs) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I 2 >50%, or Cochrane's Q p≥0.10). Methods-We searched MEDLINE, EMBASE, and Cochrane databasesResults-We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3% (95% CI 6.5%-8.1%). Laparoscopic examination identified CPP in 30% (95% CI 26%-34%). Lower age was associated with higher incidence of CPP (p<0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9% (95% CI 0.5%-1.3%). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution. Conclusions-The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients.

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Morbidity after neonatal inguinal herniotomy

Cited by 62 publications

References 5 publications

Predictors of recurrence after inguinal herniotomy in boys

Predictors of recurrence after inguinal herniotomy in boys

A simplified technique for giant inguinal hernia repair in infants

1619 Evaluation of the Contralateral Inguinal Ring in Clinically Unilateral Inguinal Hernia a Systematic Review and Meta-Analysis

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