Background: Traditionally in herniotomy, indirect hernial sac is dealt by high ligation and removal of the redundant part, to avoid recurrence. However, some authorities are of the opinion that excision of the hernial sac without ligation, is not associated with recurrence of the hernia. Some have even shown adverse events related to hernial sac ligation like increased post-operative pain and discomfort. There is no consensus on how the hernial sac should be managed during laparoscopic herniotomy. Objectives: Present study aimed to determine the feasibility of laparoscopic sac excision without ligation in paediatric age group, by a randomized comparison. Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of one year. A total of 189 patients were included in the study as per inclusion and exclusion criteria and randomized in the three groups. Comparisons were made among three procedures of laparoscopic herniotomy, namely; Percutaneous extraperitoneal closure, Intraperitoneal purse-string closure and laparoscopic sac excision without ligation. The main outcome measures were recurrence rate, operative time, hospital stay, postoperative hematoma and hydrocele formation. Results: Recurrence rate, operative time and hospital stay were not amplified in laparoscopic sac excision procedure than others. Postoperative hydrocele formation were significantly less. Conclusion: Laparoscopic sac excision in indirect paediatric inguinal hernia is safe. The procedure is not associated with early recurrence when it is performed in cases with deep ring diameter less than 10mm.
| Published in | American Journal of Pediatrics (Volume 7, Issue 4) |
| DOI | 10.11648/j.ajp.20210704.15 |
| Page(s) | 207-210 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Hernia, Inguinal, Paediatric, Laparoscopic, Sac Excision, Recurrence Rate, Intraperitoneal Purse-string, Extraperitoneal Closure
| [1] | Mohta A, Jain N, Irniraya KP, Saluja SS, Sharma S, GuptaA. Non-ligation of the hernial sac during herniotomy: a prospective study. Pediatr Surg Int 2003; 19: 451–2. |
| [2] | Gharaibeh KI, Matani YY. To ligate or not to ligate the hernial sac in adults? Saudi Med J 2000; 21: 1068–70. |
| [3] | Huang CJ, Sun HP. Non ligation of indirect hernia sac in senior male patients with dilated internal ring. Formosan J Surg 2013; 46: 76–8. |
| [4] | McClusky DA 3rd, Mirilas P, Zoras O, Skandalakis PN, Skandalakis JE. Groin hernia: anatomical and surgical history. Arch Surg 2006; 141: 1035–42. |
| [5] | Haddad M, Kamal A. Is ligation of the hernial sac necessary?J Pediatr Endosurg Innov Tech 2000; 4: 77-8. |
| [6] | Riquelme M, Aranda A, Rodriguez C, Cortinas J, Carmona G, Riquelme Q. Incidence and management of the inguinal hernia during laparoscopic orchiopexy in palpable cryptorchidism: Preliminary report. Pediatr Surg Int 2007; 23: 301-4. |
| [7] | Handa R, Kale R, Harjai MM. Laparoscopic orchidopexy: Is closure of the internal ring necessary. J Postgrad Med 2005; 51: 266-7. |
| [8] | Kumari V, Biswas N, Mitra N, Konar H, Ghosh D, Das SK. Is ligation of hernia sac during orchidopexy mandatory? J Indian Assoc Pediatr Surg 2009; 14: 66-7. |
| [9] | Ferguson DJ. Closure of the hernia sac- pro and con. In: Nyphus LM, ed. Hernia. 2nd ed. Philadelphia: Lippincott; 1978: 152–53. |
| [10] | Smedberg SGG, Broomé AEA, Gullmo A. Ligation of the hernial sac? Surg Clin North Am 1984; 64: 299–306. |
| [11] | Shulman AG, Amid PK, Lichtenstein IL. Ligation of the hernial sac. A needless step in adult hernioplasty. Int Surg 1993; 78: 152–3. |
| [12] | Abrahamson J Hernias. In: Zinner MJ, Schwartz SI, EllisH (eds) Maingot’s abdominal surgery (10th edn). Prentice Hall, London, 1997. pp 479–580. |
| [13] | Riquelme M, Aranda A, Riquelme QM. Laparoscopic pediatric inguinal hernia repair: No ligation, just resection. J Laparoendosc Adv Surg Tech A 2010; 20: 77–80. |
APA Style
Shah Md. Ahsan Shahid, Md. Nowshad Ali, Khondokar Seheli Nasrin Lina, Shantona Rani Paul, Sayed Sirajul Islam, et al. (2021). Paediatric Laparoscopic Inguinal Hernia Repair: A Comparison Among Techniques. American Journal of Pediatrics, 7(4), 207-210. https://doi.org/10.11648/j.ajp.20210704.15
ACS Style
Shah Md. Ahsan Shahid; Md. Nowshad Ali; Khondokar Seheli Nasrin Lina; Shantona Rani Paul; Sayed Sirajul Islam, et al. Paediatric Laparoscopic Inguinal Hernia Repair: A Comparison Among Techniques. Am. J. Pediatr. 2021, 7(4), 207-210. doi: 10.11648/j.ajp.20210704.15
AMA Style
Shah Md. Ahsan Shahid, Md. Nowshad Ali, Khondokar Seheli Nasrin Lina, Shantona Rani Paul, Sayed Sirajul Islam, et al. Paediatric Laparoscopic Inguinal Hernia Repair: A Comparison Among Techniques. Am J Pediatr. 2021;7(4):207-210. doi: 10.11648/j.ajp.20210704.15
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Download@article{10.11648/j.ajp.20210704.15,
author = {Shah Md. Ahsan Shahid and Md. Nowshad Ali and Khondokar Seheli Nasrin Lina and Shantona Rani Paul and Sayed Sirajul Islam and Tanzilal Lisa},
title = {Paediatric Laparoscopic Inguinal Hernia Repair: A Comparison Among Techniques},
journal = {American Journal of Pediatrics},
volume = {7},
number = {4},
pages = {207-210},
doi = {10.11648/j.ajp.20210704.15},
url = {https://doi.org/10.11648/j.ajp.20210704.15},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20210704.15},
abstract = {Background: Traditionally in herniotomy, indirect hernial sac is dealt by high ligation and removal of the redundant part, to avoid recurrence. However, some authorities are of the opinion that excision of the hernial sac without ligation, is not associated with recurrence of the hernia. Some have even shown adverse events related to hernial sac ligation like increased post-operative pain and discomfort. There is no consensus on how the hernial sac should be managed during laparoscopic herniotomy. Objectives: Present study aimed to determine the feasibility of laparoscopic sac excision without ligation in paediatric age group, by a randomized comparison. Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of one year. A total of 189 patients were included in the study as per inclusion and exclusion criteria and randomized in the three groups. Comparisons were made among three procedures of laparoscopic herniotomy, namely; Percutaneous extraperitoneal closure, Intraperitoneal purse-string closure and laparoscopic sac excision without ligation. The main outcome measures were recurrence rate, operative time, hospital stay, postoperative hematoma and hydrocele formation. Results: Recurrence rate, operative time and hospital stay were not amplified in laparoscopic sac excision procedure than others. Postoperative hydrocele formation were significantly less. Conclusion: Laparoscopic sac excision in indirect paediatric inguinal hernia is safe. The procedure is not associated with early recurrence when it is performed in cases with deep ring diameter less than 10mm.},
year = {2021}
}
TY - JOUR T1 - Paediatric Laparoscopic Inguinal Hernia Repair: A Comparison Among Techniques AU - Shah Md. Ahsan Shahid AU - Md. Nowshad Ali AU - Khondokar Seheli Nasrin Lina AU - Shantona Rani Paul AU - Sayed Sirajul Islam AU - Tanzilal Lisa Y1 - 2021/11/17 PY - 2021 N1 - https://doi.org/10.11648/j.ajp.20210704.15 DO - 10.11648/j.ajp.20210704.15 T2 - American Journal of Pediatrics JF - American Journal of Pediatrics JO - American Journal of Pediatrics SP - 207 EP - 210 PB - Science Publishing Group SN - 2472-0909 UR - https://doi.org/10.11648/j.ajp.20210704.15 AB - Background: Traditionally in herniotomy, indirect hernial sac is dealt by high ligation and removal of the redundant part, to avoid recurrence. However, some authorities are of the opinion that excision of the hernial sac without ligation, is not associated with recurrence of the hernia. Some have even shown adverse events related to hernial sac ligation like increased post-operative pain and discomfort. There is no consensus on how the hernial sac should be managed during laparoscopic herniotomy. Objectives: Present study aimed to determine the feasibility of laparoscopic sac excision without ligation in paediatric age group, by a randomized comparison. Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of one year. A total of 189 patients were included in the study as per inclusion and exclusion criteria and randomized in the three groups. Comparisons were made among three procedures of laparoscopic herniotomy, namely; Percutaneous extraperitoneal closure, Intraperitoneal purse-string closure and laparoscopic sac excision without ligation. The main outcome measures were recurrence rate, operative time, hospital stay, postoperative hematoma and hydrocele formation. Results: Recurrence rate, operative time and hospital stay were not amplified in laparoscopic sac excision procedure than others. Postoperative hydrocele formation were significantly less. Conclusion: Laparoscopic sac excision in indirect paediatric inguinal hernia is safe. The procedure is not associated with early recurrence when it is performed in cases with deep ring diameter less than 10mm. VL - 7 IS - 4 ER -
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