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A new intraperitoneal technique for safe repair of incarcerated inguinal hernias: a novel technique to consider
1Department of Paediatric Surgery, University Hospital of Wales, Cardiff, United Kingdom. ashokdram@hotmail.com
Insights
This study introduces an open intraperitoneal technique for incarcerated inguinal hernia repair in infants. The novel approach offers excellent outcomes, potentially benefiting recurrent hernia repairs as well.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Hernia Repair
Background:
- Inguinal herniotomy is a common pediatric surgical procedure.
- Emergency repair of incarcerated inguinal hernias carries higher complication risks than elective procedures.
- Existing surgical techniques include low, high, preperitoneal, and laparoscopic approaches.
Purpose of the Study:
- To describe a novel open intraperitoneal technique for incarcerated inguinal hernia repair in infants.
- To evaluate the safety and efficacy of this technique.
Main Methods:
- The study involved 6 male infants (4-40 weeks old) requiring urgent incarcerated inguinal hernia repair.
- All patients underwent the open intraperitoneal technique.
- This method allows for sac management without separating it from the vas and vessels, enables bowel inspection, and facilitates peritoneal closure through a single incision.
Main Results:
- All 6 patients experienced excellent postoperative outcomes.
- No complications were reported in the immediate postoperative period.
Conclusions:
- The open intraperitoneal technique is effective for incarcerated inguinal hernia repair in infants.
- The technique may also be suitable for complex recurrent hernia repairs.
- Potential disadvantages include postoperative hydrocele formation and the inability to directly inspect the testicle.
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.
