Page 15 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):13-16
Herniotomy in Infants, Children and Adolescents without Disruption of External Ring
Herniotomy in Infants, Children and

Adolescents without Disruption of

External Ring

2
1 AA Kareem, KM Juma’a
1 Department of Surgery, Baquba Teaching Hospital, Diayla Health Directorate, Iraq
2 Department of Clinical Pharmacy, Baquba Teaching Hospital, Diayla Health Directorate, Iraq

Abstract METHOD
Inguinal hernia is one of the commonest pediatric surgical problems
and when treated early and appropriately is associated with negligible From June 2005 till March 2007, 252 patients with inguinal hernia
morbidity and very rarely any mortality. In our prospective study we were collected in Baquba general hospital-Diayla-Iraq and
introduce a new method for repair of hernia in infants, children and managed surgically with nonlaparoscopic minimum access
adolescences without disruption of external ring. Our study involves surgery. These cases were followed up for one year for detection
252 patients with inguinal hernia, the ages ranging from 7 days to 15 of recurrence rate. The sex and age distribution of these cases
years, 8 female and the remaining male. We apply the principles of are illustrated in Table 1. From the total number, two cases only
minimal access surgery but without laparoscope that’s to say the were recurrent hernia and the remaining 250 cases were primary
smallest incision, a short stay in hospital, a rapid recovery, the least hernia. These cases were classified into two groups; group A
cost and fewer complications with no recurrence. So we can say that it which included patients below 6 years while group B included
is nonlaparoscope minimal access surgery.
patients above 6 years.
Keywords: Herniotomy, hernia repair in children. In the present prospective study we applied the principle of
minimum access surgery but without a laparoscope. Our surgery
INTRODUCTION
in group A included the approach the cord after it passed the
Inguinal hernia is a common finding in infants and children and external ring, and depending on the short inguinal canal and
represents the condition most frequently requiring surgical repair the superimposing of superficial to deep ring and with slight
1
in the pediatric age group. The incidence of inguinal hernia traction of the cord we can reach the maximal point of the sac´s
ranges from 1 to 4.4% and is higher in infants, commensurate neck and expose the extraperitoneal fat without disturbing the
2
with the higher rate of patent processus vaginalis. Boys are six inguinal canal and its content. The advantage of this which we
times more affected than girls. Hernias can be life-threatening did as a small incision not exceeding 1 cm, is that we did our
or can result in the loss of a testis, an ovary or a portion of the surgery via minimal access, keeping the inguinal canal
bowel if incarceration, strangulation or operative complications untouched so any recurrence in adulthood can dealt with as a
occur. For these complications to be avoided, timely diagnosis primary hernia.
and operative technique are important. 3 In group B who are also not needing repair neither tension
The risk of incarceration of inguinal hernia is higher in the or tension free so here we can reach the sac from above, because
neonatal period and early infancy and is easily prevented by now the inguinal canal is developed or started to develop and
early diagnosis and treatment. 4, 5 Inguinal hernia results from a applying minimum access we reach the sac just were above the
hole or defect in the muscles where the peritoneum protrudes deep ring (one inch above the midpoint of the line between the
6
from the sac or is due to a congenital patent processus pubic symphysis and interior superior iliac supine). The incision
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vaginalis. No disease belonging to the province of surgeons does not exceed 2-3 cm, then we pick-up the cord just before it
needs accurate anatomical knowledge and good surgical skill
8
more than hernia in all its varieties. Early reduction of the hernia Table 1: Age distribution
followed by elective herniotomy is the standard treatment if
there is incarceration. Emergency surgical intervention is, Age groups Male Female Total number
however, required in case of suspected or established Group A Below 1 year 76 4 2 80
70
1-3 years
72
strangulation. A very rare complication of incarcerated inguinal 3-6 years 56 2 58
hernia in infancy is the development of spontaneous bowel Group B 6-15 years 42 – 42
necrosis with enteroscrotal cutaneous fistula. 9-12 Sum 244 8 252
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