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Wang G, Liu Q, Chen G, Xia B, Zeng D, Chen G, Guo C. AI's deep dive into complex pediatric inguinal hernia issues: a challenge to traditional guidelines? Hernia 2023; 27:1587-1599. [PMID: 37843604 DOI: 10.1007/s10029-023-02900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This study utilized ChatGPT, an artificial intelligence program based on large language models, to explore controversial issues in pediatric inguinal hernia surgery and compare its responses with the guidelines of the European Association of Pediatric Surgeons (EUPSA). METHODS Six contentious issues raised by EUPSA were submitted to ChatGPT 4.0 for analysis, for which two independent responses were generated for each issue. These generated answers were subsequently compared with systematic reviews and guidelines. To ensure content accuracy and reliability, a content analysis was conducted, and expert evaluations were solicited for validation. Content analysis evaluated the consistency or discrepancy between ChatGPT 4.0's responses and the guidelines. An expert scoring method assess the quality, reliability, and applicability of responses. The TF-IDF model tested the stability and consistency of the two responses. RESULTS The responses generated by ChatGPT 4.0 were mostly consistent with the guidelines. However, some differences and contradictions were noted. The average quality score was 3.33, reliability score was 2.75, and applicability score was 3.46 (out of 5). The average similarity between the two responses was 0.72 (out of 1), Content analysis and expert ratings yielded consistent conclusions, enhancing the credibility of our research. CONCLUSION ChatGPT can provide valuable responses to clinical questions, but it has limitations and requires further improvement. It is recommended to combine ChatGPT with other reliable data sources to improve clinical practice and decision-making.
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Affiliation(s)
- G Wang
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Pediatrics, Children's Hospital, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatric General Surgery, Chongqing Maternal and Child Health Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Q Liu
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - G Chen
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - B Xia
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - D Zeng
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
| | - G Chen
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China.
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
- Department of Pediatric General Surgery, Chongqing Maternal and Child Health Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China.
| | - C Guo
- Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, People's Republic of China.
- Department of Fetus and Pediatrics, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China.
- Department of Pediatric General Surgery, Chongqing Maternal and Child Health Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
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Alshahwani N, Briatico D, Lee W, Farrokhyar F. Review and Quality Assessment of Systematic Reviews and Meta-analyses on the Management of Pediatric Inguinal Hernias: A Descriptive Study. J Surg Res 2022; 278:404-417. [PMID: 35724629 DOI: 10.1016/j.jss.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/25/2022] [Accepted: 04/05/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Research quality in pediatric surgery has been challenged by multiple factors, including the low incidence of some congenital pathologies and rare event rates. With the rapid increase of pediatric surgical literature, there is a need for systematic reviews to synthesize evidence. It is important to assess the quality of these systematic reviews. OBJECTIVE This study aims to examine the reporting of systematic reviews and meta-analyses, using inguinal hernia repair as an index diagnosis. METHODS MEDLINE, Embase, and CINAHL databases were searched for systematic reviews and/or meta-analyses of interventions on inguinal hernia in the pediatric population. The quality reporting was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2 tools. RESULTS Of 1449 unique reports, 21 studies were included (15 meta-analyses and six systematic reviews). Median percent reported items for PRISMA and AMSTAR 2 were 72.2% and 70.5%, respectively. The least reported items in PRISMA were protocol registration (27.6%), synthesis of results (13.0%), and a risk of bias across studies (20.6%). For AMSTAR 2, the least reported items were reporting of source of funding (14.3%), appropriate methods for statistical combination of results (25.0%), and pre-establishment of protocol (28.6%). All critical items were completely or partially fulfilled in 5/21 (23.8%) of the studies and completely absent in 1/21 (4.8%) studies. CONCLUSIONS The results of this study highlight relatively good reporting quality, yet a poor methodological quality of systematic reviews/meta-analyses in the pediatric surgery literature on inguinal hernia management.
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Affiliation(s)
- Noora Alshahwani
- Department of General Pediatric and Thoracic Surgery at Sidra Medicine, Doha, Qatar.
| | - Daniel Briatico
- Pediatric General Surgery Department, McMaster University, Ontario, Canada
| | | | - Forough Farrokhyar
- Professor of Epidemiology and Biostatistics Research Director, Department of Health, Evidence, Impact, McMaster University, Ontario, Canada
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Risteski T, Memeti S. Benefits of Contralateral Patent Processus Vaginalis Closure During Laparoscopic Surgery for Inguinal Hernia in Female Children. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:69-75. [PMID: 35843918 DOI: 10.2478/prilozi-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Toni Risteski
- University Clinic for Pediatric Surgery, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, RN Macedonia
| | - Shaban Memeti
- University Clinic for Pediatric Surgery, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, RN Macedonia
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Shaughnessy MP, Maassel NL, Yung N, Solomon DG, Cowles RA. Laparoscopy is increasingly used for pediatric inguinal hernia repair. J Pediatr Surg 2021; 56:2016-2021. [PMID: 33549307 DOI: 10.1016/j.jpedsurg.2021.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Inguinal hernia repairs (IHR) are commonly performed by pediatric surgeons in the United States. The operative approach depends on surgeon preference with no definitive prospective studies comparing laparoscopic inguinal hernia repair (LIHR) versus traditional inguinal hernia repair (TIHR). We aim to assess current practice, hypothesizing that laparoscopy is increasingly used for pediatric IHR. MATERIAL & METHODS The Children's Hospital Association (CHA) Pediatric Health Information System was queried for IHRs performed between 01/01/2009 and 12/31/2018. Demographics, procedure type, hernia laterality, and cost were obtained. Patients were grouped by procedure type (laparoscopic/traditional). RESULTS 125,249 IHRs were performed at 32 CHA hospitals during the ten-year study period. 115,782 (92.4%) were TIHR and 9467 (7.6%) LIHR. Use of laparoscopy increased 5-fold from 3% to 15% over the study period. When comparing laparoscopic to traditional IHR groups, there were more females (28.3% vs 12.6%), African-Americans (19.7% vs 14.4%), government-insured (50% vs 45.2%), younger patients (4.2 vs 4.4 years), bilateral IHRs (11.4% vs 7.9%), and higher adjusted total hospital cost ($3,791 vs $2995) in the laparoscopic group (p<0.0001, all comparisons). CONCLUSIONS Laparoscopy for pediatric IHR is increasing at CHA hospitals where nearly 1 in 6 children currently undergoes a laparoscopic repair. The long-term outcomes with laparoscopic repair are worthy of future study.
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Affiliation(s)
- Matthew P Shaughnessy
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Nathan L Maassel
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Nicholas Yung
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Daniel G Solomon
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States
| | - Robert A Cowles
- Department of Surgery, Division of Pediatric Surgery at Yale University, 333 Cedar St, FMB 131, New Haven, CT, United States.
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Shibuya S, Imaizumi T, Yamada S, Yoshida S, Yamada S, Toba Y, Takahashi T, Miyazaki E. Comparison of surgical outcomes between laparoscopic percutaneous extracorporeal closure (LPEC) and open repair for pediatric inguinal hernia by propensity score methods and log-rank test analysis. Surg Endosc 2021; 36:941-950. [PMID: 33616732 DOI: 10.1007/s00464-021-08354-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite a number of studies comparing laparoscopic inguinal hernia repair (LH) and open herniorrhaphy (OH), the putative advantage of LH remains controversial due to a paucity of firm evidence. We hypothesized that LH has both advantages and disadvantages compared to OH and sought to clarify them by comprehensively analyzing the retrospective data using the combination of multiple statistical methods. METHODS Operative data for inguinal hernia during the period from February 1999 to December 2019 were examined. The patients were assigned into two groups according to the surgical procedure: laparoscopic percutaneous extraperitoneal closure (LPEC, n = 2410) and OH (n = 2038). Operative and anesthesia times and incidence of postoperative complications were evaluated using the propensity score methods and log-rank test. RESULTS In comparison with OH, operative time of LPEC was longer for unilateral repair (21.59 ± 8.1 min vs 18.01 ± 8.0 min; p < 0.001) and shorter for bilateral repairs (28.55 ± 10.1 min vs 33.23 ± 11.7 min; p < 0.001), while anesthesia times were longer for both unilateral repair (57.67 ± 10.1 min vs 40.62 ± 11.9 min; p < 0.001) and bilateral repairs (65.95 ± 12.5 min vs 56.35 ± 15.1 min; p < 0.001). LPEC significantly reduced the risk of metachronous contralateral hernia (MCLH) (0.52% vs 9.29%; p < 0.001), but the recurrence rate was higher (0.21% vs 0.04%; p = 0.002) than OH. Orchiectomy due to testicular atrophy or torsion was required in 3 cases of OH (0.19%), whereas it was not seen in LPEC. CONCLUSIONS LPEC had a less risk of MCLH and testicular complications but was associated with a higher recurrence rate and longer anesthesia time. Propensity scoring techniques can enhance the robustness of retrospective comparisons between groups over several years of data collection, which is frequently required in pediatric surgery studies.
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Affiliation(s)
- Soichi Shibuya
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
| | - Takaaki Imaizumi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Susumu Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Shiho Yoshida
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Shunsuke Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Yoshie Toba
- Department of Anesthesiology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Toshiaki Takahashi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Eiji Miyazaki
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
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Staerkle RF, Guglielmetti LC, Bielicki IN, Gaukel S, Frongia G, Hilton S, Fink L, Vuille-dit-Bille RN. Is it worth to explore the contralateral side in unilateral childhood inguinal hernia?: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2020; 99:e21501. [PMID: 32756186 PMCID: PMC7402905 DOI: 10.1097/md.0000000000021501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is still not clear if the contralateral side should be explored in children with unilateral inguinal hernias. The primary aim of the present study was to assess the incidence of metachronous contralateral inguinal hernias (MCIHs) in the pediatric population. The second aim was to assess factors associated with increased risk of MCIH development. METHODS Prospective studies including patients from 0-19 years undergoing unilateral inguinal hernia repair without surgical exploration of the contralateral side between 1947 and April 2020 with a minimal follow-up of one year were searched. Searches included EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. RESULTS Seven studies involving 1774 children (1452 boys (82%) and 322 girls (18%) were identified. Overall the incidence of MCIH was 6%. Incidence of MCIH development was significantly higher in children with initial left-sided (9%) versus right-sided (3%) hernia (OR 2.55 with 95% CI from 1.56 to 4.17; P = 0.0002), in female (8%) versus male (4%) children (OR 1.74 with 95% CI from 1.01 to 3.01; P = 0.0469) and in patients with open (14%) versus closed (3%) contralateral processus vaginalis (CPV) (OR 4.17 with 95% CI from 1.25 to 13.9; P = 0.0202). There was no significant difference in MCIH development depending on follow-up duration (follow-up of ≤2 years (i.e. 1-2 years): calculated MCIH incidence 5% (95% CI from 0.00 to 0.11%; 3 studies; 569 patients), follow-up of ≥3 years (i.e. 3-4 years): 6% (95% CI from 0.03 to 0.09; 3 studies, 983 patients)) or patients' age (MCIH incidence in children <1 year: 6.9%; older children: 4.5%; OR 1.87 with 95% CI from 0.97 to 3.62; P = 0.0618). CONCLUSIONS Overall incidence of MCIH development is 6%. Initial left-sided hernia, female gender and open CPV are risk factors for MCIH development.
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Affiliation(s)
- Ralph F. Staerkle
- Clarunis University Center for Gastrointestinal and Liver Diseases, Basel
| | - Laura C. Guglielmetti
- Department of Visceral und Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur
| | | | - Stefan Gaukel
- Department of Orthopedic Surgery and Traumatology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Giovanni Frongia
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Hilton
- Department of Surgery, University of Colorado, Aurora, CO
| | - Lukas Fink
- Department of Mathematics, Cantonal School of Wil, St Gallen, Switzerland
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Gollu G, Ates U, Bahadir K, Ergun E, Yagmurlu A, Cakmak M, Aktug T, Dindar H, Bingol-Kologlu M. Transinguinal laparoscopic evaluation of contralateral side during unilateral inguinal hernia repair for children. J Pediatr Urol 2019; 15:561.e1-561.e6. [PMID: 31383517 DOI: 10.1016/j.jpurol.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inguinal hernia repair is a common procedure in daily pediatric surgical practice. OBJECTIVES The present study was planned to find out whether transinguinal laparoscopic exploration (TILE) of the contralateral groin is effective in reducing the need of operation for contralateral metachronous inguinal hernia (CMIH) in children. STUDY DESIGN Charts of 1103 children who underwent inguinal hernia repair between 2006 and 2016 were retrospectively analyzed. Eighty-eight children with bilateral hernia at the presentation were excluded, and 705 patients whose parents could be contacted by phone to get the latest information about children's condition were included in the study. RESULTS Of the 705 children with unilateral inguinal hernia repair, 362 (51.4%) and 343 (48.6%) of them had right-sided and left-sided inguinal hernia, respectively. Transinguinal laparoscopic exploration was performed in 479 of the 705 children with unilateral hernia and a hernia or contralateral patent processus vaginalis (PPV) was found and ligated in %28.3 (n = 136) of them. Mean follow-up time was 60 ± 36 months. Fifteen (4.3%) of 479 patients who had TILE and 31 (13.6%) of 226 the patients who did not have TILE developed CMIH. When the videos of 15 patients who developed CMIH were reviewed, overlooked PPV was found in 10 (3.3%) patients who had TILE during early phases of institutional learning curve. DISCUSSION AND CONCLUSIONS TILE of the contralateral side during pediatric inguinal hernia repair is a simple and effective method to evaluate contralateral PPV. This approach clearly and significantly reduces the need of operation for a metachronous hernia at a later date.
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Affiliation(s)
- G Gollu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - U Ates
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
| | - K Bahadir
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - E Ergun
- Sami Ulus Children's Hospital, Department of Pediatric Surgery, Ankara, Turkey
| | - A Yagmurlu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - M Cakmak
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - T Aktug
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - H Dindar
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | - M Bingol-Kologlu
- Ankara University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
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Jo HU, Yoo DS, Park J, Park HS, Shin HB, Woo SH. Independent risk factors for contralateral patent processus vaginalis undetected by pre-operative ultrasonography in boys with unilateral inguinal hernia. Pediatr Surg Int 2019; 35:591-595. [PMID: 30729303 DOI: 10.1007/s00383-019-04444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Many trials have been done to make sure probability of metachronous contralateral side hernia (MCH) and contralateral patent processus vaginalis (CPPV). But the necessity of contralateral side exploration is still on debate. The aim is to investigate the risk factors for the consideration of contralateral examination on operation. MATERIALS AND METHODS The study was designed as retrospectively. Patients with unilateral inguinal hernia from January 2010 to May 2015 were enrolled. Pre-operative ultrasonography was done in all patients. Patients with obvious contralateral side hernia on pre-operative US were excluded. The presence of CPPV was evaluated by transinguinal laparoscopy during the operation. RESULTS In univariate analysis, hernial sac size only shows difference (P value: 0.001). The others, location of the hernia, age at surgery, gestational age (preterm), low birth weight and parent's age, did not show statistically significant differences. Multivariate analysis also demonstrates CPPV is more common in patients with large hernial sac (Odds ratio: 2.727, 95% confidence interval 1.495-4.974, P value: 0.001). CONCLUSION We propose that surgeons should consider contralateral evaluation during operation in case with large ipsilateral hernial sac, although CPPV was not detected by pre-operative US.
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Affiliation(s)
- Hyun-Uk Jo
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Dae Seon Yoo
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Hyun Sik Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Hyun Bin Shin
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea
| | - Seung Hyo Woo
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea.
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Valioulis I, Papageorgiou I, Ioannidou D. The clinical significance of an incidentally detected open internal inguinal ring. J Pediatr Urol 2019; 15:185.e1-185.e5. [PMID: 30709588 DOI: 10.1016/j.jpurol.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/25/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE An open internal inguinal ring (IIR) may be discovered incidentally either in the context of correcting pathology involving the contralateral side or at the time of surgical exploration for reasons unrelated to a patent processus vaginalis (PPV). The aim of this study is to determine the evolution of an incidentally encountered open IIR in patients undergoing laparoscopy for reasons not associated with unilateral inguinal hernia or cryptorchidism. MATERIALS AND METHODS The authors conducted a prospective study of all patients who underwent laparoscopic surgery in the department of pediatric surgery at Agios Loukas hospital between 2004 and 2013 for various indications. Patients operated for inguinal hernia and cryptorchidism were excluded. During this period, 572 patients underwent laparoscopy for reasons not related to PPV. The median age at time of initial laparoscopy was 9,4 years (range 2 days-16 years). The IIRs were always inspected. No attempt was made to repair the open IIRs, as they were asymptomatic. Parents were informed after the operation, and instructions were given to inform us, in case that inguinal hernia symptoms manifested. The duration of the follow-up was 4 years. RESULTS Among these 572 patients, 39 patients with 44 open IIRs were found (6,82%). From the 39 patients, 35 were male and four were female; 22 had a right open IIR, 12 had a left one, and five of them a bilateral open IIR. The median age was 7,82 years (3-14 years). Four patients were lost during follow-up. Of the remaining 35 patients with 40 open IIRs, four developed an inguinal hernia (11,43%) and were operated on with laparoscopically assisted (subcutaneous endoscopically assisted ligation [SEAL]) technique at the time of diagnosis. The study results are demonstrated on Fig. 1. DISCUSSION The percentage of an incidentally discovered open IIR in this study is lower in comparison with studies including patients with PPV pathologies. There is a possibility, in those patients, of underlying pathology which can affect both sides. It is also lower in comparison with previous studies including younger patients. However, gender and side predominance is in accordance with most published studies. In this study group, the possibility of developing a symptomatic hernia from an asymptomatic open IIR is rather small. CONCLUSIONS An incidentally discovered open IIR in patients without symptoms, excluding those with contralateral inguinal hernias or cryptorchidism, has relatively low chance of developing an inguinal hernia. Thus, the authors support the strategy of close follow-up in these patients.
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Affiliation(s)
- I Valioulis
- 1(st) Department of Pediatric Surgery, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Greece; Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece.
| | - I Papageorgiou
- 1(st) Department of Pediatric Surgery, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Greece
| | - D Ioannidou
- Department of Pediatric Surgery, Agios Loukas Hospital, Panorama, Thessaloniki, Greece
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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Outcomes following laparoscopic versus open surgery for pediatric inguinal hernia repair: Analysis using a national inpatient database in Japan. J Pediatr Surg 2019; 54:577-581. [PMID: 29661573 DOI: 10.1016/j.jpedsurg.2018.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study compared perioperative outcomes between laparoscopic surgery (LS) and open surgery (OS) for pediatric inguinal hernia repair, using a national inpatient database. METHODS Using the Diagnosis Procedure Combination database in Japan, we compared duration of anesthesia, postoperative complications, recurrence, and metachronous hernia (MH) between LS and OS for children undergoing inguinal hernia repair from July 2010 to March 2016. We used multivariable logistic regression analysis for postoperative complications and Cox regression analysis for recurrence. RESULTS For 75,486 eligible patients (LS 20,186 vs. OS 55,300), the median follow-up was 815 (381-1350) days in LS and 1106 (576-1603) days in OS. The duration of anesthesia was significantly longer in LS than in OS for unilateral surgery (80 vs. 70min, p<0.001) but shorter for bilateral surgery (86 vs. 96min, p<0.001). LS had a lower proportion of MH than OS (0.3% vs. 3.4%, p<0.001). There was no significant difference between LS and OS in complications (odds ratio: 0.55; 95% confidence interval: 0.22-1.38; p=0.20) or recurrence (hazard ratio: 1.24; 95% confidence interval: 0.86-1.79; p=0.89). CONCLUSIONS LS patients had lower proportions of MH than OS patients. Complications and recurrence did not differ significantly between LS and OS. TYPE OF STUDY Retrospective study. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo.
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11
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Kim Y. Characteristics and recent therapeutic trends of pediatric inguinal hernia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yeajeong Kim
- Department of General Surgery, Presbyterian Medical Center, Jeonju, Korea
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12
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Is contralateral inguinal exploration necessary in preterm girls undergoing inguinal hernia repair during the first months of life? Pediatr Surg Int 2018; 34:1151-1155. [PMID: 30120549 DOI: 10.1007/s00383-018-4334-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND To assess the need for contralateral surgical exploration in preterm girls with symptomatic unilateral inguinal hernia. METHODS The medical data of girls operated for inguinal hernia between 2004 and 2016 in a single pediatric surgery center were retrospectively collected. Preterm girls operated for unilateral hernia before 6 months of life were selected (55/517 cases) to assess the incidence and risk factors for contralateral metachronous inguinal hernia (CMIH). RESULTS CMIH was observed in 7% of cases (4 girls with a right inguinal hernia in 3 cases) at a mean age of 4.2 years. Only one case occurred early (3 months). Birth weight and term were comparable (1674 ± 620 g and 32 ± 5 WA without CMIH vs. 1694 ± 582 g and 33 ± 3 WA with CMIH). CONCLUSION Contralateral inguinal hernia is very rare and generally occurs several years after inguinal repair surgery in preterm girls, which should encourage practitioners to follow these children throughout childhood for the subsequent development of inguinal hernia. This study did not find any arguments in favor of systematic contralateral exploration in preterm girls.
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13
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Inguinal hernia in preterms in neonatal intensive care units: Optimal timing of herniorrhaphy and necessity of contralateral exploration in unilateral presentation. J Pediatr Surg 2018; 53:2155-2159. [PMID: 29628207 DOI: 10.1016/j.jpedsurg.2018.02.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND We sought to determine the optimal timing of IH repair in preterms and the need for routine contralateral exploration. METHODS Medical records of 3690 pediatric patients who underwent unilateral IH repair between January 1998 and December 2009 were reviewed. We assessed medical record review and telephone interviews. In total, 1990 patients were enrolled in the study. Early, early-delayed, and late repair were defined as herniorrhaphy performed within 7 days of diagnosis, later than 7 days of diagnosis, and after discharge from the NICU, respectively. RESULTS Of 1990 patients, 90 preterms and 1900 full-terms were included. Among these, 7, 11 and 72 preterm patients received early, early-delayed and late IH repairs, respectively. Preoperative incarceration and postoperative complication rates were not different, but the recurrence rate was higher in the early repair group. Two group analysis of early and early-delayed vs. late repairs indicated similar results. The rates of synchronous and metachronous bilateral IH (SBIH, MBIH) were observed to be higher and the diagnostic interval of MBIH was shorter in preterms than in full-terms (35.6% vs. 15.9%, P < 0.001; 12.2% vs. 6.3%, P < 0.001; 5.2 vs. 41.8 months, P = 0.003). CONCLUSION Our results indicate that IH repair is safe to perform in preterm babies in the NICU at a delayed or late stage since the preoperative incarceration and recurrence rates were not different. Contralateral exploration could be considered in preterms because the rates of SBIH and MBIH were significantly higher and the MBIH diagnosis interval was shorter than in full-terms. LEVEL OF EVIDENCE III, treatment study.
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Van Batavia JP, Tong C, Chu DI, Kawal T, Srinivasan AK. Laparoscopic inguinal hernia repair by modified peritoneal leaflet closure: Description and initial results in children. J Pediatr Urol 2018; 14:272.e1-272.e6. [PMID: 29958645 PMCID: PMC6084465 DOI: 10.1016/j.jpurol.2018.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/07/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Inguinal hernias are common in infants and children. While the gold standard for hernia repair in the pediatric period has been via an open inguinal incision with dissection and high ligation of the hernia sac, over the past two decades laparoscopic herniorrhaphy has increased in popularity. The advantages of laparoscopy include decreased post-operative pain, improved cosmetic results, ability to easily assess the contralateral side for an open internal inguinal ring, and decreased risk of metachronous hernias. Herein, we describe a modified laparoscopic herniorrhaphy using a peritoneal leaflet closure and report our operative experience with intermediate-term results. METHODS We retrospectively reviewed our IRB-approved registry for all children who underwent initial laparoscopic herniorrhaphy at our tertiary care center over a 2.5-year period. All surgeries were performed by a single surgeon using a technique we have termed the peritoneal leaflet closure. This technique involves incising the peritoneum circumferentially around the open internal ring and developing peritoneal leaflets which are then closed together over the ring with a running non-absorbable barbed stitch (Figure). Intraoperative findings and complications, operative times, and post-operative complications were reviewed for all children. RESULTS A total of 50 initial laparoscopic hernia repairs (4 bilateral, 42 unilateral) were performed in 46 children (43 boys, 3 girls) at a median age of 5.9 years (range 0.5-16.7). Median operative time was 73 min (range 48-138) for unilateral and 106 min (range 104-135) for bilateral herniorrhaphy. No patient had an intraoperative complication. Two children (4%) had contralateral open rings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. All patients went home on the same day as the procedure and three children (6%) had minor post-operative complaints (umbilical bulge, thigh pain, and urine holding) that all self-resolved. Thirty-nine children had follow-up data available. Intermediate-term complications occurred in two children (5%): one boy developed a contralateral hydrocele (despite a closed ring at surgery) and one boy had a hernia recurrence that required open repair. Overall, operative success with the modified peritoneal leaflet closure technique was therefore 97% (38 of 39 children with follow-up). All 37 boys who followed up had bilateral descended testes of normal size and consistency. CONCLUSIONS Laparoscopic herniorrhaphy using a peritoneal leaflet closure technique is safe and effective when used in infants and children to close an indirect hernia (i.e. patent processus vaginalis). No intraoperative complications occurred in this cohort and success rate was 97%.
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Affiliation(s)
- Jason P Van Batavia
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
| | - Carmen Tong
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA
| | - David I Chu
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Trudy Kawal
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Arun K Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
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Baradaran N, Wood CM, McCoy OO, Prasad MM, Stec AA. Laparoscopic intra-abdominal patent processus vaginalis ligation in pediatric urology practice. J Pediatr Urol 2017; 13:512.e1-512.e6. [PMID: 28465160 DOI: 10.1016/j.jpurol.2017.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/22/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE Inguinal hernias and communicating hydroceles from a patent processus vaginalis (PPV) are common problems in children. This study provides a detailed description of the laparoscopic intra-abdominal patent processus vaginalis ligation (LIPPL) procedure along with its results in pediatric urology patients. METHODS Prospectively collected data were captured from children (<18 years) who underwent LIPPL from 2012 to 2014. Demographics as well as postoperative characteristics were reviewed and descriptively analyzed. LIPPL is performed using a 5-mm camera through the umbilicus. A loop of polypropylene suture is passed through a spinal needle percutaneously on one side of the internal ring. The needle is reinserted on the opposite side and the tail of the suture is fed through the original loop such that a purse-string is created around the peritoneum of the internal ring above the spermatic vessels and the vas; the suture is tied extracorporeally. RESULTS 142 patients (3 female) were evaluated with 197 PPV sites repaired using LIPPL at median 24 (1-216) months of age. Median operating time was 35 (20-91) and 43 (27-85) minutes for unilateral and bilateral repairs, respectively. There were no intraoperative complications. During the 14 (1-34) months from surgery, there were no hernia recurrences, one surgical site infection, seven patients with residual small non-communicating hydroceles, and one patient who developed a suture granuloma. CONCLUSIONS LIPPL is a safe and effective technique with minimal rate of hernia recurrence and few complications. LIPPL allows for easy repair of all sizes of PPV, with patients receiving the benefits of minimally invasive surgery including the ability to evaluate the contralateral inguinal ring.
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Affiliation(s)
- Nima Baradaran
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Case M Wood
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Olugbemisola O McCoy
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Michaella M Prasad
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew A Stec
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA.
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16
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Wright NJ, Davidson JR, Major C, Durkin N, Tan YW, Jobson M, Ade-Ajayi N, Hall NJ, Bouhadiba N. The management of boys under 3 months of age with an inguinal hernia and ipsilateral palpable undescended testis. J Pediatr Surg 2017; 52:1108-1112. [PMID: 28292594 DOI: 10.1016/j.jpedsurg.2017.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 12/29/2022]
Abstract
AIMS The optimal management for boys under 3 months of age with an indirect inguinal hernia (IIH) and ipsilateral palpable undescended testis (IPUDT) is unknown. We aimed to: 1) determine the current practice for managing these boys across the UK, and 2) compare outcomes of different treatment strategies. METHODOLOGY We undertook two studies. Firstly, we completed a National Survey of all surgeons on the British Association of Paediatric Surgeons email list in 2014. Subsequently, we undertook a multi-centre, retrospective, 10-year (2005-2015) review across 4 pediatric surgery centers of boys under 3months of age with concomitant IIH and IPUDT. Primary outcome was testicular atrophy. Secondary outcomes included need for subsequent orchidopexy, testicular ascent and hernia recurrence. Data are presented as median (range). Chi-squared test and multivariate binomial logistic regression analysis were used for analysis; p<0.05 was considered significant. RESULTS Survey: Consultant practice varies widely across the UK, with a tendency towards performing concurrent orchidopexy at the time of herniotomy under 3 months of age. Concurrent orchidopexy is favored less in cases where the hernia is symptomatic. Case Series Review: Forty-one boys with 43 concomitant IIH and IPUDT were identified, and all included. 32 (74%) hernias were reducible, 11 (26%) were symptomatic requiring urgent or emergency repair. Post-conceptual age at surgery was 45weeks (36-65). Primary operations included: 29 (67%) open hernia repair and standard orchidopexy, 8 (19%) open hernia repair with future orchidopexy if required, 4 (9%) laparoscopic hernia repair with future orchidopexy if required, 2 (5%) open hernia repair and suturing of the testis to the inverted scrotum without scrotal incision. Variation in atrophy rate between different surgical approaches did not reach statistical significance (p=0.42). Overall atrophy rate was 18%. If hernia repair alone was undertaken (8 open and 4 laparoscopic), the testis did not descend in 8 patients, requiring subsequent orchidopexy (67%); if orchidopexy was undertaken at the time of hernia repair, 1 in 29 required a repeat orchidopexy (3%) (p=0.0001). No hernia recurred. CONCLUSION This study suggests that orchidopexy at the time of inguinal herniotomy does not increase the risk of testicular atrophy in boys under 3months of age.
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Affiliation(s)
- Naomi J Wright
- Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK; Department of Paediatric Surgery, University Hospital Lewisham, London, UK.
| | - Joseph R Davidson
- Department of Paediatric Surgery, University Hospital Lewisham, London, UK
| | - Christina Major
- Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK
| | - Natalie Durkin
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Yew-Wei Tan
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Matthew Jobson
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nordeen Bouhadiba
- Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK; Department of Paediatric Surgery, University Hospital Lewisham, London, UK
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17
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Zhu LL, Xu WJ, Liu JB, Huang X, Lv ZB. Comparison of laparoscopic hernia repair and open herniotomy in children: a retrospective cohort study. Hernia 2017; 21:417-423. [DOI: 10.1007/s10029-017-1607-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 04/04/2017] [Indexed: 12/21/2022]
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18
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The challenging sonographic inguinal canal evaluation in neonates and children: an update of differential diagnoses. Pediatr Radiol 2017; 47:461-472. [PMID: 27832304 DOI: 10.1007/s00247-016-3706-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
Bulging of the inguinal region is a frequent complaint in the pediatric population and sonographic findings can be challenging for radiologists. In this review we update the sonographic findings of the most common disorders that affect the inguinal canal in neonates and children, with a focus on the processus vaginalis abnormalities such as congenital hydroceles, indirect inguinal hernias and cryptorchidism, illustrated with cases collected at a quaternary hospital during a 7-year period. We emphasize the importance of correctly classifying different types of congenital hydrocele and inguinal hernia to allow for early surgical intervention when necessary. We have systematically organized and illustrated all types of congenital hydrocele and inguinal hernias based on embryological, anatomical and pathophysiological findings to assist readers in the diagnosis of even complex cases of inguinal canal ultrasound evaluation in neonates and children. We also present rare diagnoses such as the abdominoscrotal hydrocele and the herniation of uterus and ovaries into the canal of Nuck.
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Weaver KL, Poola AS, Gould JL, Sharp SW, St Peter SD, Holcomb GW. The risk of developing a symptomatic inguinal hernia in children with an asymptomatic patent processus vaginalis. J Pediatr Surg 2017; 52:60-64. [PMID: 27842956 DOI: 10.1016/j.jpedsurg.2016.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with a symptomatic indirect inguinal hernia have a patent processus vaginalis (PPV). However, the reverse is unknown, as the natural history of PPV is unclear. Currently, there are little data regarding the incidence and time frame for developing a symptomatic hernia with a known asymptomatic PPV. METHODS A retrospective chart review was conducted in children who were evaluated for a PPV during nonhernia laparoscopic surgery by a single pediatric surgeon (GWH) from 2000 to 2014. Those patients with intraoperative findings of PPV were followed up by chart review and phone inquiry. RESULTS 1548 children underwent a laparoscopic operation, with 308 having an asymptomatic PPV. Phone contact was successful in 125 (43%) of these patients at a median of 8.1years (range 4.8-12.7) after the initial laparoscopic operation. Nineteen (13%) patients returned with a symptomatic hernia at a median age of 17months (range: 5-74) and a median presentation of 9months (range: 1-66) after the initial laparoscopy. Ten hernia repairs were unilateral and 9 bilateral. None of those who were contacted via phone inquiry reported hernia symptoms or hernia repair. CONCLUSIONS These data suggest that the risk of developing a symptomatic hernia during childhood in the presence of a known PPV is relatively low. LEVEL OF EVIDENCE Level 3; type of study: retrospective study.
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Affiliation(s)
- Katrina L Weaver
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Ashwini S Poola
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Joanna L Gould
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Susan W Sharp
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - George W Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
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20
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Lee CH, Chen Y, Cheng CF, Yao CL, Wu JC, Yin WY, Chen JH. Incidence of and Risk Factors for Pediatric Metachronous Contralateral Inguinal Hernia: Analysis of a 17-Year Nationwide Database in Taiwan. PLoS One 2016; 11:e0163278. [PMID: 27684710 PMCID: PMC5042430 DOI: 10.1371/journal.pone.0163278] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/05/2016] [Indexed: 11/22/2022] Open
Abstract
Background Previous prospective, retrospective, and meta-analysis studies revealed that the overall incidence of metachronous contralateral inguinal hernia (MCIH) ranges from 5.76% to 7.3%, but long-term follow-up postoperative data are scant. We identified the incidence and risk factors of MCIH in pediatric patients during the follow-up using the Taiwan National Health Insurance Research Database (NHIRD). Methods Between 1996/01/01 and 2008/12/31, all pediatric patients with primary unilateral inguinal hernia repair who were born after 1996/01/01 were collected via ICD-9 diagnostic and procedure codes recorded in NHIRD. Patients with another operation during the same admission, complicated hernia, or laparoscopic procedure were excluded. Several reported risk factors, including age, sex, preterm birth, low body weight, and previous ventriculoperitoneal shunt placement, were used for analysis. The primary endpoint was the repairmen of MCIH following the initial surgery. All patients were followed until 2013/12/31 or withdrawal from national health insurance. Results A total of 31,100 pediatric patients underwent unilateral inguinal hernia repair, and 111.76 months of median follow-up data were collected. The overall rate of MCIH was 12.3%. Among the 31,100 patients who had the hernia repair, 63.6% had MCIH within 2 years and 91.5% had MCIH within 5 years. After initial surgery, the incidence of MCIH gradually and significantly decreased with age up to approximately 6 years. Multivariable analysis showed that age <4 y and girls were risk factors for subsequent MCIH. Conclusions After 17 years of follow-up, the overall MCIH rate was 12.3%, and 91.7% of patients needed repair for MCIH within the first 5 years after initial surgery. Age <4 years and girls were risk factors for MCIH. The contralateral exploration for inguinal hernia should be considered among these patients.
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Affiliation(s)
- Cheng-Hung Lee
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yun Chen
- Department of Surgery, Far Eastern Memorial Hospital, Pan-Ciao, New Taipei, Taiwan
| | - Chi-Fu Cheng
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chao-Lin Yao
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Chung-Li, Taoyuan City, 32003, Taiwan
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Chung-Li, Taoyuan City, 32003, Taiwan
| | - Jin-Chia Wu
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Yao Yin
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jian-Han Chen
- Department of General Surgery, Buddhist Dalin Tzu Chi Hospital, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- * E-mail:
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Sasse T, Moehrlen U, Meuli M, Vuille-dit-Bille RN. Exploration of the contralateral side when operating for inguinal hernia in children for detection of bilateral hernation. Hippokratia 2016. [DOI: 10.1002/14651858.cd009352.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tom Sasse
- University of Zürich; Institute of Physiology; Zürich Switzerland
| | - Ueli Moehrlen
- University Children's Hospital of Zurich; Pediatric Surgery; Steinwiesstrase 75 Zürich Switzerland 8032
| | - Martin Meuli
- University Children's Hospital of Zurich; Pediatric Surgery; Steinwiesstrase 75 Zürich Switzerland 8032
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Watanabe T, Yoshida F, Ohno M, Mori M, Tomita H, Ukiyama E, Nakano M, Endo M. Morphology-based investigation of metachronous inguinal hernia after negative laparoscopic evaluation - is it acquired indirect inguinal hernia? J Pediatr Surg 2016; 51:1548-51. [PMID: 27524736 DOI: 10.1016/j.jpedsurg.2016.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/10/2016] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients who developed apparent metachronous contralateral inguinal hernia (MCIH) after negative laparoscopic diagnosis have been reported. We performed this study to investigate the morphological characteristics and etiology of this phenomenon. PATIENTS AND METHODS A consecutive series of 1,747 patients (858 boys and 889 girls) with symptomatic unilateral inguinal hernia were studied. During laparoscopic percutaneous completely extraperitoneal closure, morphological appearances at the asymptomatic groin were inspected for contralateral patent processus vaginalis (CPPV) with definitive criteria. If positive CPPV was identified, it was closed by the same technique used for the affected side. The patients were reviewed for occurrence of metachronous contralateral hernia. RESULTS A total of 755 patients (43.2%) had positive CPPV. Of the 992 patients whose CPPVs were evaluated as true negative, eight (seven boys, one girl) developed MCIH (time taken, three months to five years six months). During second-look operations, morphological appearances of the CPPV that was originally considered as true negative CPPV was found to be wide open. CONCLUSIONS Despite a true negative evaluation by laparoscopy, there was a 0.8% chance of developing a MCIH. This phenomenon was male-oriented and may be acquired indirect inguinal hernia without preceding of CPPV.
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Affiliation(s)
- Toshihiko Watanabe
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan.
| | - Fumiko Yoshida
- Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan
| | - Michinobu Ohno
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan
| | - Masaharu Mori
- Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan
| | - Hirofumi Tomita
- Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan
| | - Etsuji Ukiyama
- Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan; Department of Pediatric Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Miwako Nakano
- Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan
| | - Masao Endo
- Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan
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Abstract
The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic and groin problems. In this article we review the current technique, indications, benefits and complications of laparoscopy in diagnosis and management of various groin problems in children including undescended testes (non-palpable and palpable) and inguinal hernia.
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Affiliation(s)
- Himanshu Aggarwal
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
| | - Barry A Kogan
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
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Wenk K, Sick B, Sasse T, Moehrlen U, Meuli M, Vuille-dit-Bille RN. Incidence of metachronous contralateral inguinal hernias in children following unilateral repair - A meta-analysis of prospective studies. J Pediatr Surg 2015; 50:2147-54. [PMID: 26455468 DOI: 10.1016/j.jpedsurg.2015.08.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/22/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this review was to systematically evaluate the incidence of a metachronous contralateral inguinal hernia (MCIH) in children with unilateral inguinal hernia and therefore to propose or to reject routine contralateral groin exploration. METHODS Electronic searches restricted to prospective studies with a minimal follow-up of 1year included MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. RESULTS Six studies involving 1669 children were included. Overall MCIH was 6% (95% CI from 4% to 8%). The odds for MCIH development were significantly larger in children with an initial left-sided hernia (OR 2.66 with 95% CI from 1.56 to 4.53) and in children with open contralateral processus vaginalis (CPV) (OR 4.17 with 95% CI from 1.25 to 13.9). CONCLUSIONS The overall incidence of MCIH following unilateral inguinal hernia repair in children is 6%. Initial left-sided hernia (8.5%) and open CPV (13.8%) are risk factors for MCIH development. Female gender (8.2%) and younger age (<1year) (6.9%) non-significantly increase the risk of MCIH.
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Affiliation(s)
- Kathrin Wenk
- Emergency Department, Hospital Baden, Baden, Switzerland
| | - Beate Sick
- Epidemiology, Biostatistics, and Prevention Institute (EBPI) at the University of Zurich, Zürich, Switzerland
| | - Tom Sasse
- University of Zurich, Zürich, Switzerland
| | - Ueli Moehrlen
- Pediatric Surgery, University Children's Hospital of Zurich, Zürich, Switzerland
| | - Martin Meuli
- Pediatric Surgery, University Children's Hospital of Zurich, Zürich, Switzerland
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Chin TW, Pan ML, Lee HC, Tsai HL, Liu CS. Second hernia repairs in children-a nationwide study. J Pediatr Surg 2015; 50:2056-9. [PMID: 26385566 DOI: 10.1016/j.jpedsurg.2015.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Second inguinal hernia repairs may be needed either owing to contralateral metachronous hernia (MH) or ipsilateral recurrent hernia (RH). In this study, we estimated the incidence rates of MH and RH from a large nationwide database. METHODS The information was obtained from the National Health Insurance Database (with 23 million insurants). Subjects with hernia repairs were identified, and information such as age, gender, unilateral/bilateral procedures in the first and second hernia repairs were analyzed. RESULTS Among the 92,308 newborns observed from their births to the end of 6th year, 3881 had first hernia repairs. Among the 3068 subjects with first unilateral repairs, 307 had second repairs, and among the 813 with first bilateral repairs, 15 had second repairs. The incidence of second repairs was 10.85% (13.71% if <1year old) after first unilateral repairs and was 1.23% (0.63% if <1year old) after first bilateral repairs. CONCLUSIONS The incidence of RH (estimated from second hernia repairs after first bilateral repairs) was 1.23%. The incidence of MH (from second repairs after first unilateral repairs) was 9.62%. These incidence rates are consistent with other published reports.
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Affiliation(s)
- Tai-Wai Chin
- Pediatric Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Mei-Lien Pan
- Institute of Information Science, Academia Sinica, Taipei, Taiwan
| | - Hui-Chen Lee
- Experimental Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Lin Tsai
- Pediatric Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Su Liu
- Pediatric Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Centeno-Wolf N, Mircea L, Sanchez O, Genin B, Lironi A, Chardot C, Birraux J, Wildhaber BE. Long-term outcome of children with patent processus vaginalis incidentally diagnosed by laparoscopy. J Pediatr Surg 2015; 50:1898-902. [PMID: 26233492 DOI: 10.1016/j.jpedsurg.2015.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/10/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patent processus vaginalis (PPV) might be incidentally diagnosed during laparoscopy. The aims of this study were to determine the prevalence and the natural history of PPV, i.e. its possible development into symptomatic inguinal hernia. INCLUSION CRITERIA children <16years undergoing laparoscopy for pathologies other than processus vaginalis (PV) related, from 10/2000-10/2005. EXCLUSION CRITERIA past or present history of PV-related pathologies. The internal inguinal rings were documented during laparoscopy. Follow-up was provided by phone inquiry and clinical examination if needed. Median follow-up was 10.5years (range 7.1-12.8). RESULTS 416 patients were included. Median age at laparoscopy was 12.4years (range 3days-18.1years). Forty-three PPV (33 unilateral, 5 bilateral) were found in 38 patients (9.1%). Four children with PPV presented later with an ipsilateral inguinal hernia (10.5%, 95%CI [3%; 25%]), at a median age of 16.0years (range 11.8-17.3), at a median of 22.5months (range 12-50) after initial laparoscopy, as compared to no patient in the population with obliterated PV (0%, 95%CI [0%; 1%]). CONCLUSION 9.1% of the observed pediatric population showed an asymptomatic PPV, and 10.5% of these children later developed an inguinal hernia. None of the children with obliterated PV developed a hernia.
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Affiliation(s)
- N Centeno-Wolf
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - L Mircea
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - O Sanchez
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - B Genin
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - A Lironi
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - C Chardot
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - J Birraux
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - B E Wildhaber
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland.
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Lee DG, Lee YS, Park KH, Baek M. Risk factors for contralateral patent processus vaginalis determined by transinguinal laparoscopic examination. Exp Ther Med 2015; 9:421-424. [PMID: 25574209 PMCID: PMC4280956 DOI: 10.3892/etm.2014.2098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 11/27/2014] [Indexed: 11/23/2022] Open
Abstract
Concurrent contralateral inguinal exploration in children with unilateral hernia or hydrocele is a subject of debate. The aim of the present study was to investigate the incidence of contralateral patent processus vaginalis (CPPV) using transinguinal laparoscopy (inguinoscopy). In addition, the risk factors of CPPV were evaluated in order to facilitate the selection of appropriate candidates for contralateral examination. A total of 119 patients who presented with unilateral hydrocele, inguinal hernia or cryptorchidism between 2001 and 2008 underwent inguinoscopy during the ipsilateral surgery. All data were collected prospectively. The incidence of CPPV was investigated and the risk factors affecting the presence of CPPV were analyzed. Among these patients, 29 individuals (24.4%) had CPPV confirmed by inguinoscopy. No surgical complications were observed during the inguinoscopy. Cases with suspicious ultrasound findings were at a higher risk of CPPV than cases with normal findings (odds ratio, 13.800; P=0.004). A history of contralateral disease was also found to be a significant risk factor (odds ratio, 4.008; P=0.019). The present study identified that the significant risk factors for CPPV were suspicious findings on ultrasound examination and a history of contralateral disease. Therefore, it is concluded that performing inguinoscopy in children with these risk factors is beneficial.
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Affiliation(s)
- Dong-Gi Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Young-Suk Lee
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Kwan Hyun Park
- Seoul Samsung Urology Clinic/Gynecology Health Care Center, Ulsan, Republic of Korea
| | - Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Sarr A, Sow Y, Fall B, Ze Ondo C, Thiam A, Ngandeu M, Diao B, Fall PA, Ndoye AK, Ba M, Diagne BA. [Pathology of the processus vaginalis in urological practice]. Prog Urol 2014; 24:665-9. [PMID: 25214297 DOI: 10.1016/j.purol.2014.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/14/2014] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. PATIENTS AND METHODS We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. RESULTS A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. CONCLUSION Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- A Sarr
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal.
| | - Y Sow
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - B Fall
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - C Ze Ondo
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - A Thiam
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - M Ngandeu
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - B Diao
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - P A Fall
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - A K Ndoye
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - M Ba
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
| | - B A Diagne
- Service d'urologie-andrologie, hôpital Aristide le Dantec, Dakar, Sénégal
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Kokorowski PJ, Wang HHS, Routh JC, Hubert KC, Nelson CP. Evaluation of the contralateral inguinal ring in clinically unilateral inguinal hernia: a systematic review and meta-analysis. Hernia 2013; 18:311-24. [PMID: 23963735 DOI: 10.1007/s10029-013-1146-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/28/2013] [Indexed: 11/25/2022]
Abstract
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. METHODS We searched MEDLINE, EMBASE, and Cochrane databases (1940-2011) using 'hernia' and 'inguinal' and either 'pediatric,' 'infant,' or 'child,' to identify studies of pediatric (age ≤21 years) 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). RESULTS 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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Affiliation(s)
- P J Kokorowski
- Division of Urology, Children's Hospital Los Angeles, Institute of Urology, University of Southern California, 4650 Sunset Blvd., #114, Los Angeles, CA, 90027, USA,
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Shah R, Arlikar J, Dhende N. Incise, dissect, excise and suture technique of laparoscopic repair of paediatric male inguinal hernia. J Minim Access Surg 2013; 9:72-5. [PMID: 23741112 PMCID: PMC3673577 DOI: 10.4103/0972-9941.110966] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/05/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Authors report incise, dissect, excise and suture (IDES) technique of laparoscopic repair of paediatric male inguinal hernia (LRPMIH). This series retrospectively evaluates a consecutive personal series of children undergoing laparoscopic hernia repair by this new technique. MATERIALS AND METHODS: It is a retrospective review of the LRPMIH done by single surgeon from January 2001 to December 2007. All male patients who were referred to the first author for management of inguinal hernia were given the option of laparoscopic repair. Parents who gave consent for their child to undergo LRPMIH were retrospectively reviewed. RESULTS: A total of 155 patients were operated. Age group was 2 months to 13 years (average-5 years). Follow-up period ranges from 1 to 7 years. Average operating time was 29 min for unilateral and 40 min for bilateral inguinal hernia. Maximum time required was 50 min which was for bilateral inguinal hernia. Bilateral inguinal hernia was present in 10 (6.4%) patients. There were no intraoperative complications. Contralateral processus vaginalis was patent in 25 (16.12%) patients. In the immediate post-operative period 8 patients had port site surgical emphysema which resolved on its own. There are no recurrences so far. One patient developed port site hernia, which was repaired with the standard surgery. There is no incidence of clinical testicular atrophy. CONCLUSION: LRPMIH can be done as routine procedure and also has fewer complications. It has advantage of diagnosing and repairing contra lateral patent processus vaginalis. However a double-blind controlled study is required to establish the results.
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Affiliation(s)
- Rasik Shah
- Department of Pediatric Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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Hoshino M, Sugito K, Kawashima H, Goto S, Kaneda H, Furuya T, Hosoda T, Masuko T, Ohashi K, Inoue M, Ikeda T, Tomita R, Koshinaga T. Prediction of contralateral inguinal hernias in children: a prospective study of 357 unilateral inguinal hernias. Hernia 2013; 18:333-7. [PMID: 23644774 PMCID: PMC4037557 DOI: 10.1007/s10029-013-1099-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 04/26/2013] [Indexed: 11/26/2022]
Abstract
Purpose Previously, we established a pre-operative risk scoring system to predict contralateral inguinal hernia in children with unilateral inguinal hernias. The current study aimed to verify the usefulness of our pre-operative scoring system. Methods This was a prospective study of patients undergoing unilateral inguinal hernia repair from 2006 to 2009 at a single institution. Gender, age at initial operation, birth weight, initial operation side, and the pre-operative risk score were recorded. We analyzed the incidence of contralateral inguinal hernia, risk factors, and the usefulness of our pre-operative risk scoring system. The follow-up period was 36 months. We used forward multiple logistic regression analysis to predict contralateral hernia. Results Of the 372 patients who underwent unilateral hernia repair, 357 (96.0 %) were completely followed-up for 36 months, and 23 patients (6.4 %) developed a contralateral hernia. Left-sided hernia (OR = 5.5, 95 %, CI = 1.3–24.3, p = 0.023) was associated with an increased risk of contralateral hernia. The following covariates were not associated with contralateral hernia development: gender (p = 0.702), age (p = 0.215), and birth weight (p = 0.301). The pre-operative risk score (cut-off point = 4.5) of the patients with a contralateral hernia was significantly higher, compared with the patients without a contralateral hernia using the area under the receiver operating characteristic curve (p = 0.024). Conclusions Using multivariate analysis, we confirmed usefulness of our pre-operative scoring system and initial side of the inguinal hernia, together, for the prediction of contralateral inguinal hernia in children.
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Affiliation(s)
- M. Hoshino
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - K. Sugito
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - H. Kawashima
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - S. Goto
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - H. Kaneda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Furuya
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Hosoda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Masuko
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - K. Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - M. Inoue
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Ikeda
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - R. Tomita
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - T. Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
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Tam YH, Wong YS, Chan KW, Pang KKY, Tsui SY, Mou JWC, Sihoe JDY, Lee KH. Simple maneuvers to reduce the incidence of false-negative findings for contralateral patent processus vaginalis during laparoscopic hernia repair in children: a comparative study between 2 cohorts. J Pediatr Surg 2013; 48:826-9. [PMID: 23583141 DOI: 10.1016/j.jpedsurg.2012.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/07/2012] [Accepted: 07/18/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transumbilical or transinguinal laparoscopic evaluation for contralateral patent processus vaginalis (CPPV) is commonly performed during laparoscopic or open hernia repair in children but may occasionally give false-negative findings. METHODS A retrospective study was conducted to compare 2 cohorts of children who underwent laparoscopic repair for clinically demonstrated unilateral inguinal hernia and evaluation for CPPV by transumbilical laparoscopy during the study periods of 2004 to 2007 (cohort 1) and 2008 to 2011 (cohort 2). Cohort 1 was a known historical cohort with CPPV being evaluated by laparoscopic inspection alone, whereas additional maneuvers were adopted in cohort 2. RESULTS There were 395 and 564 patients in cohorts 1 and 2, respectively. There was no difference between the 2 cohorts in age of patients, sex distribution, laterality of clinically demonstrated inguinal hernia, and follow-up period at the time of data collection. More CPPV were diagnosed in cohort 2 than cohort 1(36.2% vs 25.8%; P < .01). 4 children (1.4%) developed metachronous inguinal hernia following negative laparoscopic evaluation for CPPV in cohort 1 compared with none from cohort 2 at a similar median follow-up period (P < .05). CONCLUSIONS The additional maneuvers appear to be superior to laparoscopic inspection alone to evaluate CPPV during laparoscopic hernia repair in children.
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Affiliation(s)
- Yuk Him Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, NT, The Chinese University of Hong Kong, Hong Kong, China.
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Tam YH, Wong YS, Pang KKY, Tsui SY, Mou JWC, Houben CH, Chan KW, Lee KH. Unexpected Metachronous Hernia Development in Children Following Laparoscopic Unilateral Hernia Repair with Negative Evaluation for Contralateral Patent Processus Vaginalis. J Laparoendosc Adv Surg Tech A 2013; 23:287-90. [PMID: 23336437 DOI: 10.1089/lap.2012.0365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuk Him Tam
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuen Shan Wong
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kristine Kit Yi Pang
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Siu Yan Tsui
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jennifer Wai Cheung Mou
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Christopherus Heinrich Houben
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kin Wai Chan
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kim Hung Lee
- Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Aggarwal H, Kogan BA, Feustel PJ. One third of patients with a unilateral palpable undescended testis have a contralateral patent processus. J Pediatr Surg 2012; 47:1711-5. [PMID: 22974611 DOI: 10.1016/j.jpedsurg.2012.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/01/2012] [Accepted: 01/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the incidence and predictive factors associated with a contralateral patent processus vaginalis in boys with a unilateral palpable undescended testis. METHODS We retrospectively reviewed the records of 77 consecutive boys (median age, 15 months; range, 5 months to 17.7 years) who had undergone orchiopexy for a unilateral palpable testis. At inguinal orchiopexy, an 8F feeding tube and a 70° adult cystoscope lens were placed into the peritoneum through the hernia sac, and the contralateral internal ring was inspected. The clinical factors that might predict the presence of a contralateral patent processus vaginalis were determined. RESULTS The overall rate of a contralateral patent processus vaginalis was 34% in those with a significant ipsilateral hernia sac. After considering age, side, prematurity, location, and volume of the undescended testis, only the boys with a testis distal to the external ring compared with those with testes lying within the inguinal canal had statistically increased odds of a patent contralateral processus vaginalis (odds ratio, 3.1; 95% confidence interval, 1.08-9.08). CONCLUSION Approximately one third of boys with a unilateral palpable undescended testis will have a contralateral patent processus vaginalis as determined by transinguinal laparoscopy. The rate is higher (52%) if the undescended testis was distal to the external ring. Both the etiology and significance of this contralateral finding are unknown.
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Wang JH, Zhang W, Tou JF, Huang SJ, Liu WG, Xiong QX, Zhao ZY. Incidence of pediatric metachronous contralateral inguinal hernia in children aged ≥1 year. World J Pediatr 2012; 8:256-9. [PMID: 22886200 DOI: 10.1007/s12519-012-0367-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The management of the contralateral asymptomatic side when a child with initial unilateral inguinal hernia undergoes herniorrhaphy continues to be controversial. Age less than 6 months at initial herniorrhaphy is considered as a high risk factor of the occurrence of metachronous contralateral inguinal hernia (MCIH). We performed herniorraphy for patients ≥1 year with initial unilateral hernia at one-day-set outpatient-surgery department without any intervention of contralateral groin. In this study, we reviewed the characteristics of development of MCIH in this condition and discuss the management strategies of MCIH. METHODS The subjects of this study were children who were treated at our outpatient-surgery department from January 2006 to December 2006. A total of 2129 patients with initial unilateral hernia and aged ≥1 year underwent an ipsilateral herniorhhaphy only. Patients were followed up for the development of MCIH to 60 months. The Chi-square test was used for intergroup comparison, a level of P<0.05 was considered as statistically significant. RESULTS Among these children 1341 (63.0%) were obtained 60 months follow-up data, 1146 (85.5%) were boys and 195 (14.5%) were girls. MCIH developed in 70 (5.2%) patients, 61 were boys and 9 were girls. In 570 patients aged 12-23 months, 43 developed MCIH (7.5%); in 564 patients aged 24-59 months, 21 developed MCIH (3.7%); and in 207 patients ≥60 months, 6 patients developed MCIH (2.9%), the difference between these groups was highly significant (P=0.004). In male patients, 30 right-sided MCIHs occurred after 423 initial left-sided herniorrhaphies (7.1%) and 31 left-sided MCIHs occurred after 723 initial right-sided herniorrhaphies (4.3%), difference between these two groups was significant (P=0.041). Seventy-seven percent of the MCIHs occurred within 1 year, 94% occurred within 2 years after initial herniorraphy. CONCLUSIONS As the overall incidence of MCIH in patients aged ≥1 year was 5.2%, routine contralateral groin exploration is not suggested. Transinguinal laparoscopy could be considered as an alternative of conventional "wait and see" policy, especially in patients less than 2 years or left-sided initial unilateral inguinal hernia. If "wait and see" policy is adopted, patients should be closely followed up for 2 years.
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Affiliation(s)
- Jin-Hu Wang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Lao OB, Fitzgibbons RJ, Cusick RA. Pediatric inguinal hernias, hydroceles, and undescended testicles. Surg Clin North Am 2012; 92:487-504, vii. [PMID: 22595705 DOI: 10.1016/j.suc.2012.03.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric inguinal hernias are extremely common, and can usually be diagnosed by simple history taking and physical examination. Repair is elective, unless there is incarceration or strangulation. Hydroceles are also quite common, and in infancy many will resolve without operative intervention. Undescended testicles harbor an increased risk of infertility and malignancy, and require orchiopexy in early childhood.
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Affiliation(s)
- Oliver B Lao
- Department of Pediatric Surgery, Children's Hospital and Regional Medical Center, University of Nebraska College of Medicine, 8200 Dodge, Omaha, NE 68114, USA
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Lazar DA, Lee TC, Almulhim SI, Pinsky JR, Fitch M, Brandt ML. Transinguinal laparoscopic exploration for identification of contralateral inguinal hernias in pediatric patients. J Pediatr Surg 2011; 46:2349-52. [PMID: 22152880 DOI: 10.1016/j.jpedsurg.2011.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 09/03/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The use of transinguinal laparoscopy for contralateral groin exploration during unilateral inguinal hernia repair has gained popularity. Controversy exists, however, regarding its use in older children. We report a large, single-surgeon series describing the safety and effectiveness of this procedure. METHODS A retrospective review was completed of all cases of open inguinal hernia repair from 1997 to 2009 performed by the senior author. Patients were explored laparoscopically through the ipsilateral hernia sac to assess the contralateral groin. Exclusion criteria were an inadequate sac or preoperatively diagnosed bilateral inguinal hernia. RESULTS A total of 649 children underwent open inguinal hernia repair. A preoperative diagnosis of bilateral hernia was made in 18% (n = 117), and of the 532 unilateral cases, an inadequate sac was present in 15% (n = 79). Transinguinal laparoscopic exploration was performed on the remaining 453 children. A hernia or contralateral patent processus vaginalis (CPPV) was found in 38% of children (n = 173). In children older than 8 years, 32% demonstrated a hernia or CPPV on laparoscopic exploration. No complications occurred because of laparoscopy. CONCLUSION Transinguinal laparoscopic exploration is safe and effective and should be routinely performed in pediatric patients of all ages because of the high prevalence of contralateral hernia and CPPV.
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Affiliation(s)
- David A Lazar
- Michael E. DeBakey Department of Surgery,Baylor College of Medicine, Houston, TX 77030, USA
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Systematic review for paediatric metachronous contralateral inguinal hernia: a decreasing concern. Pediatr Surg Int 2011; 27:953-61. [PMID: 21604078 DOI: 10.1007/s00383-011-2919-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Controversy still surrounds the treatment of the asymptomatic inguinal region in paediatric patients with a unilateral inguinal hernia. The concern is the development of a future metachronous contralateral inguinal hernia (MCIH) and therefore the need for a second operation. Our aim was to provide a current systematic review of the evidence for routine contralateral exploration, and identify potential at-risk groups. METHODS Comprehensive review of the literature utilising broad search terms to identify all relevant publications. Precise inclusion and exclusion criteria to identify studies that included paediatric unilateral inguinal hernia repair without routine contralateral exploration. DATA ANALYSIS Chi-square with Yates' correction or a Fisher's exact test as appropriate. Numbers needed to treat (NNT) calculated with 95% confidence intervals. RESULTS A total of 7,130 titles and abstracts were screened and 61 studies included with data on 49,568 paediatric patients with a unilateral inguinal hernia fulfilling the inclusion criteria. 2,857 of these patients later developed a MCIH, revealing an overall risk is 5.76% (95% CI: 5.55-5.97%). The NNT for a MCIH is 18 (95% CI: 16.8-18) with 18 contralateral exploration required for the prevention of one MCIH. Patients <6 months at the time of the initial intervention were more likely to develop a MCIH; 183/1,470 (<6/12) versus 144/2,044 (≥6/12), P < 0.0001. As were patients with an original left-sided hernia; 815/6,739 versus 865/12,615, P < 0.0001. The NNTs for both of these groups were 9. There was no association with the gender of the patient; 888/14,480 (♂) versus 268/4,206 (♀), P = 0.37. CONCLUSIONS There is insufficient evidence to support the routine contralateral inguinal exploration in all paediatric patients presenting with a unilateral inguinal hernia. However, with patients presenting with an originally left-sided hernia or who are less than 6 months old, a parental discussion should occur about the possible benefits and risks of contralateral exploration.
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Baird R, Gholoum S, Laberge JM, Puligandla P. Prematurity, not age at operation or incarceration, impacts complication rates of inguinal hernia repair. J Pediatr Surg 2011; 46:908-11. [PMID: 21616251 DOI: 10.1016/j.jpedsurg.2011.02.059] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Inguinal hernia repair (IHR) remains the most common procedure in pediatric surgery. Although postoperative sequelae are well described, we examined if prematurity and age were important determinants of postoperative complications. METHODS A retrospective review of children younger than 2 years undergoing IHR from 2004 to 2007 was performed, with a minimum of 1-year follow-up. Patients were segregated into groups based on age at diagnosis (A, 0-3; B: 4-26; C: 27-52; D: 53-104 weeks), with or without prematurity. Incarceration rates were investigated. Complications were categorized as major (vas injury, recurrence, testicular atrophy) or minor (wound infection, "high" testicle, hydrocele) and compared. RESULTS Two hundred sixty-eight patients were analyzed (98 premature), with 14 major complications (5.2%) and 26 (9.7%) minor complications overall. Groups A and B accounted for more major (12/14) and minor complications (22/26) when compared with groups C and D (P < .005). In patients less than 26 weeks (groups A and B), premature infants had more complications than term infants (27.7% vs 12.1%, P = .01). Of 22 patients with incarcerated hernias, 2 (9.1%) had major complications (P < .5 vs nonincarcerated patients). CONCLUSIONS Our study suggests that prematurity, rather than age at operation or incarceration, affects complication rates after IHR. This information should be used to frame the discussion of informed consent for this commonly performed procedure.
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Affiliation(s)
- Robert Baird
- Division of Pediatric General Surgery, The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada H3H 1P3
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Saad S, Mansson J, Saad A, Goldfarb MA. Ten-year review of groin laparoscopy in 1001 pediatric patients with clinical unilateral inguinal hernia: an improved technique with transhernia multiple-channel scope. J Pediatr Surg 2011; 46:1011-4. [PMID: 21616272 DOI: 10.1016/j.jpedsurg.2010.12.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 11/30/2010] [Accepted: 12/23/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this 10-year review of data is to verify the effectiveness, safety, and appropriate age group for using a multichannel scope during inguinal herniorrhaphy in pediatric patients with clinical unilateral inguinal hernia to evaluate for contralateral patent processus vaginalis (CPPV). METHODS The data evaluated are age, sex, negative findings, positive findings, false positives, false negatives, recurrences, date of recurrence, and complications. Patients who clinically had bilateral hernias or were born prematurely were excluded. A 5-mm, 30° multichannel scope was used through the ipsilateral open hernia sac to explore the contralateral internal ring. A Fogarty catheter was used through one of the channels of the scope to probe the contralateral side in instances of questionable patent processus vaginalis. RESULTS One thousand one patients were studied, and a total of 237 CPPVs (23%) were identified. The highest incidence of CPPV was found in those patients younger than 1 year (44%). Contralateral patent processus vaginalis was identified and ligated in 34% of patients younger than 2 years, 20% in patients 2 to 8 years old, and 17% of patients 9 to 18 years old. There were no false positives and 6 false negatives (0.6%) of the contralateral side. There were 3 (0.3%) recurrent inguinal hernias of the ipsilateral side and no complications. CONCLUSIONS The use of a multichannel scope through the ipsilateral open hernia sac during inguinal herniorrhaphy in pediatric patients with clinical unilateral inguinal hernia to evaluate for CPPV proved to be effective, cost-effective, and safe. Our procedure eliminated any additional scars and the cost of trocars and permitted us to probe the contralateral internal ring. Unnecessary open exploration was spared in 56% of children younger than 1 year and proved to be useful in all pediatric patients up to the age of 18 years.
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Affiliation(s)
- Saad Saad
- Monmouth Medical Center, NJ 07712, USA
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A tailored approach for the treatment of indirect inguinal hernia in adults—an old problem revisited. Langenbecks Arch Surg 2010; 396:187-92. [DOI: 10.1007/s00423-010-0635-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 02/25/2010] [Indexed: 01/28/2023]
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Are there any predictive factors of metachronous inguinal hernias in children with unilateral inguinal hernia? Hernia 2009; 13:613-5. [DOI: 10.1007/s10029-009-0537-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 07/08/2009] [Indexed: 11/25/2022]
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The degree to which the size and side of an inguinal hernia is predictive of a hernia on the other side. Pediatr Surg Int 2009; 25:229-33. [PMID: 19139909 DOI: 10.1007/s00383-008-2310-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The indication for contralateral exploration in patients with a unilateral inguinal hernia and the implications of a contralateral patent processus vaginalis have been the subject of much debate during recent decades. The aim of this study was to investigate whether the size and side of the hernial sac on the side of presentation are predictive for the operative appearance of the processus vaginalis/hernial sac on the contralateral side. METHODS All primary herniotomies performed by the Christchurch-based paediatric surgical service were reviewed. Patients who developed a contralateral hernia after unilateral repair were identified. In a random subset of patients who had bilateral exploration for unilateral hernias, the size of the clinical hernial sac was plotted against the size of the contralateral patent processus vaginalis/hernial sac (when present) as assessed at the time of open surgery. RESULTS Overall, 2,124 unique patients underwent herniotomies in the period reviewed, and 44 (3.8%) metachronous contralateral hernias were identified. Girls were not at greater risk than boys of developing a metachronous hernia. There was a positive correlation between the size of the clinical hernial sac and the size of the contralateral processus vaginalis/hernial sac. There was no significant relationship between the original presenting side and the development of a metachronous contralateral hernia. CONCLUSION It is not possible to predict reliably which patients who present with a unilateral hernia would benefit from bilateral exploration, although the size of the hernia has a positive correlation with the size of the contralateral processus vaginalis/hernial sac. Those with "massive" hernias on the presenting side were more likely to have "large" contralateral hernial sacs, but how many of these would subsequently become symptomatic remains uncertain.
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Kalantari M, Shirgir S, Ahmadi J, Zanjani A, Soltani AE. Inguinal hernia and occurrence on the other side: a prospective analysis in Iran. Hernia 2009; 13:41-3. [DOI: 10.1007/s10029-008-0411-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 06/17/2008] [Indexed: 11/29/2022]
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Stegani MM, Agulham MA, Ioshii SO. Testicular morphological damage in young rats after inguinotomy with vascular trauma. J Pediatr Surg 2008; 43:1705-10. [PMID: 18779011 DOI: 10.1016/j.jpedsurg.2008.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 01/13/2008] [Accepted: 01/14/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Operations for the treatment of inguinal diseases are the most frequent in childhood. Bleeding owing to trauma to the spermatic vessels is frequent and can cause testicular atrophy. The goal of this work was to determine the effects of the trauma to the spermatic vessels in the prepubertal and postpubertal histopathologic alterations in an experimental model in Wistar rats. METHODS Eighty albino Wistar rats were divided in 4 groups for the histopathologic analysis. In group A, they were submitted to digital compression of the spermatic vessels for 45 seconds; in group B, the spermatic vessels were clamped with hemostats for 5 seconds; in group C, the spermatic vessels were cauterized for 2 seconds. Group D was the control group, in which the animals were submitted to inguinotomy solely. RESULTS The prepubertal histopathologic alterations were significantly decreased in group A for testicular weight (0.97 +/- 0.10); in group B, for testicular weight (0.81 +/- 0.24), testicular volume (0.522 +/- 0.192), and mean testicular biopsy score (7.2 +/- 2.7); and in group C, for the 5 parameters studied, testicular weight (0.69 +/- 0.28), testicular weight per 100 g of body weight (0.498 +/- 0.188), testicular volume (0.765 +/- 0.308), mean seminiferous tubular diameter (236.6 +/- 62.5), and mean testicular biopsy score (6.9 +/- 3.1). The postpubertal histopathologic alterations were not significant for any of the 5 parameters studied, in the 3 groups. CONCLUSIONS The prepubertal histopathologic alterations were more intense in the group submitted to cauterization of the spermatic vessels, intermediate in the group submitted to clamping of the spermatic vessels with hemostats, and less severe in the rats submitted to digital compression of the spermatic vessels. The postpubertal histopathologic alterations demonstrated the capability of the young testicle to recuperate from a vascular trauma.
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Palmer LS, Rastinehad A. Incidence and Concurrent Laparoscopic Repair of Intra-abdominal Testis and Contralateral Patent Processus Vaginalis. Urology 2008; 72:297-9; discussion 299. [DOI: 10.1016/j.urology.2007.12.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 11/26/2022]
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Contralateral inguinal hernia in childhood and youth: which child will develop a contralateral inguinal hernia? Hernia 2008; 12:631-4. [DOI: 10.1007/s10029-008-0403-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
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Maddox MM, Smith DP. A long-term prospective analysis of pediatric unilateral inguinal hernias: should laparoscopy or anything else influence the management of the contralateral side? J Pediatr Urol 2008; 4:141-5. [PMID: 18631911 DOI: 10.1016/j.jpurol.2007.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 09/12/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To prospectively determine if children who present with a unilateral inguinal hernia can be identified as at risk for developing a metachronous inguinal hernia (MIH) based on risk factors and laparoscopic findings of the contralateral internal ring. MATERIALS AND METHODS Between April 2000 and October 2004, 299 patients with a unilateral inguinal hernia were followed prospectively. Laparoscopy was attempted in each child. Bilateral repair was only performed in those with contralateral swelling or crepitus during laparoscopic evaluation. All other children were followed regardless of laparoscopic findings. Risk factors to include premature delivery, family history and increased abdominal pressure were recorded. Clinical follow up and annual phone interviews were performed to determine the development of a MIH. RESULTS Thirteen patients underwent initial bilateral inguinal hernia repair. Of the remaining 286 patients (272 boys, 14 girls; ages 54+/-50.8 months), laparoscopy revealed 127 closed, 48 cleft and 67 open (contralateral patent processus vaginalis) contralateral internal rings, and in 44 laparoscopy was not possible due to a small hernia. Of 222 patients followed for 53.2 months (30.1-82.5 months), 15 (6.8%) developed a MIH. When comparing age, gender, laterality, laparoscopic findings, family history, premature birth and intra-abdominal pressure, only family history exhibited a significant risk for MIH (33% vs 7.7%). However, 16/21 children with a family history never developed a MIH, and 47/53 children with a contralateral patent processus vaginalis have yet to develop one. CONCLUSIONS Risk factors and laparoscopic findings failed to predict the few children who would develop a MIH. The contralateral side should not be routinely explored by any methodology.
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Affiliation(s)
- M M Maddox
- East Tennessee Children's Hospital, Knoxville, TN, USA
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Hernioscopy: a useful technique for the evaluation of incarcerated hernias that retract under anaesthesia. Hernia 2007; 12:133-5. [DOI: 10.1007/s10029-007-0296-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 10/12/2007] [Indexed: 11/26/2022]
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