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Surgical treatment of inguinal herniae in children
1Department of General Surgery, Chesterfield and North Derbyshire Royal Hospital, Calow, Chesterfield Derbyshire, S44 5BL, UK. k.ravi@virgin.net
Insights
This study found no standard surgical technique for pediatric inguinal hernia repair, with approaches varying by surgeon experience and patient age. Trends, not standards, were observed in surgical methods for pediatric inguinal herniotomy.
Area of Science:
- Pediatric Surgery
- Surgical Techniques
Background:
- Inguinal hernia repair in children is common.
- Standardization of surgical techniques is often sought to improve outcomes.
Purpose of the Study:
- To determine if a standard surgical technique exists for pediatric inguinal hernia repair.
- To assess if routine opening of the inguinal canal varies by patient age and surgeon experience.
Main Methods:
- A postal survey was sent to 264 consultant surgeons in England.
- Questionnaires assessed surgical techniques for inguinal herniotomy in different age groups.
- Techniques were compared between specialist and general units, and by surgeon volume.
Main Results:
- The response rate was 69%.
- Only 23% of surgeons in specialist units and 8% in general units performed over 30 herniotomies annually.
- 15% always opened the inguinal canal, 56% operated superficial to the external ring, and 29% used both approaches. Techniques varied with age, with specialist pediatric surgeons more likely to open the canal.
- No standard technique was identified; only trends were observed.
Conclusions:
- There is no universally adopted standard surgical technique for inguinal hernia repair in children.
- Surgical approaches show trends influenced by patient age, surgeon specialization, and operative volume.
Abstract:
The aim of this paper was to assess if there is a standard technique for the repair of inguinal herniae in children and to establish if the inguinal canal should be routinely opened during this procedure in different age groups. A postal survey was conducted by sending questionnaires to 264 consultant surgeons who were surgical tutors or advisors to the Royal College of Surgeons of England. Information was sought using a multiple-choice tick-box questionnaire. The surgical techniques of surgeons working in specialist units were compared with those working in general units, and comparisons were also drawn between surgeons performing more operations than those doing only a few and also if the technique varied with the age of the patient. The response rate was 69%. Only 23% working in specialist units and 8% from general units performed more than 30 herniotomies per year. Overall, 15% of surgeons always performed the operation through the inguinal canal, 56% performed it superficial to the external ring, and 29% tended to do both. In children under the age of 2 years, most surgeons performed the operation superficial to the external ring, although a higher proportion of surgeons at specialist units opened the inguinal canal routinely. In the older age groups, the tendency to open the inguinal canal and/or divide the external ring was greater. However, surgeons at specialist paediatric units and those performing more than 30 herniotomies in a year were more likely to open the inguinal canal without dividing the external ring in all age groups. There was quite obviously no standard surgical technique for inguinal herniotomy in children in this survey, and there are only trends.