A New Intraperitoneal Technique for Safe Repair of Incarcerated Inguinal Hernias: A Novel Technique to Consider

Abstract

Introduction: Inguinal herniotomy is one of the most common operations performed by paediatric surgeons. Most procedures are elective operations but occasionally the hernia is incarcerated. Complications after emergency repair of an incarcerated hernia repair are higher than those associated with elective surgery because of congestion of the sac. Operative techniques described so far include low, high, preperitoneal and laparoscopic approaches. We describe here an open intraperitoneal technique.

Methods: 6 boys aged between 4–40 weeks were taken urgently to the operating room for incarcerated inguinal hernia repair. All boys were operated on using an open intraperitoneal technique. In this technique, the congested sac does not need to be separated from the adherent vas and vessels within the inguinal canal, the reduced bowel can be inspected with 3D visualisation and resected if necessary, and the peritoneum can be easily incised and sutured through a single skin incision, reducing the risk of complications and providing superior cosmesis.

Results: All patients had very good postoperative outcomes with no complications.

Conclusions: The technique can be used not only for incarcerated inguinal hernia repair but also for problematic repairs of recurrent hernias. Disadvantages include postoperative hydrocele formation and failure to inspect the testicle.

Key words

incarcerated - intraperitoneal - inguinal hernia

References

• 1 Cox JA. Inguinal hernia of childhood.  Surg Clin North Am. 1985;  65 1331-1342
• 2 Hebra A. eMedicine: Paediatric Hernias.  2006;  [Online] Accessed May 2008. Available at URL: http://www.emedicine.com/ped/topic2559.htm
• 3 Rowe MI, O’Neill JA, Grosfeld JL. et al .eds Essentials of Paediatric Surgery.. 4th Edition. St Louis: Mosby; 1995: 446-452
• 4 Misra D, Hewitt G, Potts SR. et al . Inguinal herniotomy in young infants, with emphasis on premature neonates.  J Paediatr Surg. 1994;  29 (11): 1496-1498
• 5 Ashcraft KW, Holcomb GW, Murphy JP. Paediatric Surgery.. 4th Edition. Philadelphia: Elsevier Saunders; 2005: 703
• 6 Burge DM, Griffiths DM, Steinbrecher HA. et al .Paediatric Surgery.. 2nd edition. Hodder Arnold: London; 2005: 304-307

Correspondence