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Open inguinal herniotomy: Analysis of variations
Musa Ibrahim1, Mu'azu Adamu Ladan, Umar Sharif Abdussalam
1Department of Surgery, Children Surgical Unit, Murtala Muhammad Specialist Hospital, Kano, Nigeria.
Insights
Open external ring, sac twisting, and double ligation do not improve congenital inguinal hernia repair outcomes in children. Simpler methods like single ligation are equally effective and faster.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Congenital Abnormalities
Background:
- Congenital groin hernia and hydrocele repair is a common pediatric surgical procedure.
- Limited literature compares outcomes of different open herniotomy approaches.
- This study evaluates efficacy of external ring incision, sac twisting, and double ligation versus single ligation.
Purpose of the Study:
- To compare the efficacy of various surgical techniques in open herniotomy for congenital inguinal hernia and/or hydrocele in children.
- To determine if opening the external ring, twisting the hernial sac, or using double ligation offers advantages over single ligation.
Main Methods:
- A multi-center prospective randomized clinical trial involving 428 pediatric patients.
- Patients were randomized into four groups: RO (ring opened, sac twisted, double ligated), ST (sac twisted, double ligated, no ring opening), DL (double ligated, no ring opening or twisting), and SL (single ligated, no ring opening or twisting).
Main Results:
- Operation time was significantly shorter in the DL (17 min) and SL (15 min) groups compared to RO (27 min) and ST (21 min) (P < 0.0001).
- Mean paracetamol dosage per patient was lowest in the DL (2.18) and SL (1.87) groups, indicating less postoperative pain compared to RO (3.96) and ST (2.94) (P < 0.0001).
Conclusions:
- Opening the external ring, twisting the hernial sac, and double ligation of the processus vaginalis do not confer any advantage in congenital inguinal hernia repair.
- Simpler techniques, such as single ligation without external ring incision or sac twisting, are associated with shorter operation times and potentially less postoperative pain.
Background:
Repair of congenital groin hernia/hydrocele is the most common surgical procedure performed by paediatric surgeons. There is dearth of literature comparing the outcomes of open herniotomy in children using various surgical approaches. This study was aimed at evaluating the efficacy of open herniotomy by comparing external ring incision, hernial sac twisting and whether or not double ligation has benefit over a single suture application.
Materials And Methods:
A multi-centre prospective randomised clinical trial was conducted with a total of 428 patients having congenital inguinal hernia and/or hydrocele. Patients were randomly assigned into four groups: RO (had external ring opened, hernial sac twisted and doubly ligated), ST (had hernial sac twisted and doubly ligated without opening the ring), DL (had double ligation of hernial sac without ring opening nor twisted) while SL (had single ligation of hernial sac with neither ring opening nor sac twisting).
Results:
A total of 458 repairs were done. Patients' age ranged from 0.25 years (3 months) to 21 years in group RO with mean of 4.87 × 4.07 (median, 4), 0.069 years (24 days) to 17 years in group ST with mean of 4.23 × 4.03 (median, 3), 0.5 years (6 months) to 16 years in group DL with mean of 4.59 × 3.87 (median, 4) and 1 year to 19 years in group SL with mean of 5.00 × 4.19 (median, 4). Operation time per repair was 26.50 × 5.46 min, range 16-40 min (median, 27 min) in group RO, 22.18 × 5.34 min, range 12-39 min (median, 21 min) in group ST while 17.98 × 3.40 min with range of 12-39 min (median, 17 min) in group DL and 15.27 × 4.18 min, range 7-40 min (median, 15 min) in group SL P < 0.0001. The mean paracetamol dose/patient was 3.96 × 1.43, 2.94 × 0.81, 2.18 × 0.69, 1.87 × 0.78 in group RO, ST, DL and SL, respectively, P < 0.0001.
Conclusion:
Congenital inguinal hernia repair with opening of the external ring, hernia sac twisting and double ligation of the processus vaginalis confers no advantage.
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