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A tailored approach for the treatment of indirect inguinal hernia in adults--an old problem revisited
Martin Hübner1, Markus Schäfer, Hicham Raiss
1Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Insights
Patent processus vaginalis peritonei (PPV) in adults is common, occurring in 14% of hernia repairs. Annulorrhaphy offers a faster procedure with similar recurrence rates and fewer neuropathic symptoms compared to mesh repair.
Area of Science:
- General Surgery
- Abdominal Wall Reconstruction
- Hernia Surgery
Background:
- A patent processus vaginalis peritonei (PPV) typically presents as an indirect inguinal hernia in children.
- Knowledge regarding PPV in adult populations and optimal treatment strategies remains limited.
Purpose of the Study:
- To investigate the incidence, characteristics, and outcomes of adult PPV.
- To compare the efficacy of annulorrhaphy versus mesh repair for adult PPV.
Main Methods:
- A prospective cohort study of patients undergoing ambulatory open hernia repair.
- Demographics, hernia characteristics, and outcomes were assessed for patients with PPV.
- Annulorrhaphy was used for internal inguinal ring diameters <30 mm; mesh repair was used otherwise.
Main Results:
- PPV was diagnosed in 14% of 676 hernia repairs (92 cases).
- The median age was 34 years, with 89% of patients being male.
- Annulorrhaphy resulted in shorter operative times (38 vs. 48 min) with comparable recurrence, chronic pain, and hypoesthesia rates.
- A trend towards fewer neuropathic symptoms was observed with annulorrhaphy (0/41 vs. 5/51).
Conclusions:
- PPV is a significant finding in adult hernia repairs, present in 14% of cases.
- Annulorrhaphy is a viable, time-efficient option for selected adult PPV patients.
- Annulorrhaphy demonstrates comparable recurrence rates and a potential advantage in reducing neuropathic symptoms.
Purpose:
A patent processus vaginalis peritonei (PPV) presents typically as an indirect hernia with an intact inguinal canal floor during childhood. Little is known however about PPV in adults and its best treatment.
Methods:
A cohort study included all consecutive patients admitted for ambulatory open hernia repair. In patients with a PPV, demographics, hernia characteristics, and outcome were prospectively assessed. Annulorrhaphy was the treatment of choice in patients with an internal inguinal ring diameter of <30 mm.
Results:
Between 1998 and 2006, 92 PPVs (two bilateral) were diagnosed in 676 open hernia repairs (incidence of 14%). Eighty nine of the 90 patients were males, the median age was 34 years (range: 17-85). A PPV was right-sided in 67% and partially obliterated in 66%. Forty-one patients had an annulorrhaphy and 51 patients had a tension-free mesh repair. The median operation time was significantly shorter in the annulorrhaphy group (38 vs. 48 min, P<.0001). In a median follow-up period of 56 months (27-128), both groups did not differ concerning recurrence (1/41 vs. 2/51), chronic pain (3/41 vs. 4/51), and hypoesthesia (5/41 vs. 9/51). There was however a clear trend to less neuropathic symptoms in favor of annulorrhaphy (0/41 vs. 5/51, P < 0.066).
Conclusions:
PPV occurs in 14% of adults undergoing hernia repair. In selected patients, annulorrhaphy takes less time and is associated with equally low recurrence but less potential for neuropathic symptoms.
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