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A longitudinal follow-up using the high trans-scrotal approach for inguinal and scrotal abnormalities in boys
1Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey. gokcora@medicine.ankara.edu.tr
Insights
The high trans-scrotal incision offers superior outcomes for pediatric inguinal hernia repair compared to traditional suprapubic incisions. This method improves wound healing and reduces complications, leading to better cosmetic and clinical results for children.
Area of Science:
- Pediatric Surgery
- Surgical Incisions
- Inguinal Hernia Repair
Background:
- The suprapubic transverse inguinal incision is a common surgical approach for pediatric inguinal pathologies.
- Alternative surgical techniques warrant investigation for improved patient outcomes.
Purpose of the Study:
- To compare the clinical efficacy and safety of the high trans-scrotal skin-crease incision versus the suprapubic transverse inguinal incision for pediatric inguinal pathologies.
Main Methods:
- A prospective randomized study involving 256 male infants and children with inguinal pathologies (primarily indirect inguinal hernias).
- Patients were surgically treated using the high trans-scrotal incision and compared to 278 controls who underwent the suprapubic transverse inguinal incision.
- Outcomes assessed included wound healing, infection, edema, seroma, hematoma, testicular complications, and recurrence rates over 84 months.
Main Results:
- The high trans-scrotal incision group demonstrated significantly better outcomes in wound healing, reduced infection, edema, seroma, hematoma, and testicular complications.
- Recurrence rates of the primary pathology were lower in the study group.
- Cosmetic and clinical results were more favorable with the high trans-scrotal incision.
- An acceptable morbidity rate of approximately 5% was observed, considering nosocomial infections, incarceration, and emergency surgery.
Conclusions:
- The high trans-scrotal skin-crease incision is clinically superior to the suprapubic transverse inguinal incision for pediatric inguinal pathologies.
- Wider adoption and further clinical experience with the high trans-scrotal incision are recommended to optimize surgical results in pediatric patients.
Abstract:
The popular incision for surgical approach to pediatric inguinal pathologies has been the suprapubic transverse inguinal incision. Yet alternative incisions may be considered. A prospectively randomized study of a consecutive series of 256 male infants and children with various inguinal pathologies (mainly indirect inguinal hernias) were treated surgically using the "high trans-scrotal skin-crease incision," over a period of 84 months (7 years) and were compared and found to be clinically better than age- and sex-matched 278 controls with suprapubic transverse inguinal incisions for wound healing/infection, edema, seroma, hematoma, malpositioning or atrophy of testes and recurrence of the primary pathology. The results in the study group were cosmetically and clinically more favorable, and better than the control group. Nosocomial infections, complications of incarceration, and emergency surgery have resulted in an acceptable morbidity rate of approximately 5%. Popularized use of the high trans-scrotal incision and further clinical experience is recommended to facilitate even better results.
