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Incarcerated Pediatric Hernias
Sophia A Abdulhai1, Ian C Glenn1, Todd A Ponsky1
1Division of Pediatric Surgery, Akron Children's Hospital, One Perkins Square, Akron, OH 44308, USA.
Insights
Pediatric inguinal hernias are common, especially in premature infants. Timely surgical repair, including laparoscopic options, is recommended for incarcerated hernias, even in preterm neonates.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
Background:
- Indirect inguinal hernias are the most frequent incarcerated hernias in children.
- Premature and low birth weight infants exhibit a higher incidence.
- Contralateral groin exploration for subclinical hernias remains a debated topic due to low progression rates.
Purpose of the Study:
- To review the management of incarcerated inguinal hernias in pediatric patients.
- To evaluate the efficacy and safety of laparoscopic repair versus open surgery.
- To discuss the controversial practice of contralateral groin exploration.
Main Methods:
- Review of current literature on pediatric incarcerated inguinal hernias.
- Analysis of outcomes for nonoperative reduction and surgical repair techniques.
- Comparison of laparoscopic and open surgical approaches for hernia repair.
Main Results:
- Most indirect inguinal hernias are reducible nonoperatively.
- Timely repair is advised for all pediatric inguinal hernias, including in premature infants.
- Laparoscopic repair is a safe and effective alternative for incarcerated inguinal hernias.
- Other rare incarcerated pediatric hernias can be managed effectively with laparoscopy.
Conclusions:
- Prompt surgical intervention for incarcerated inguinal hernias in children is crucial.
- Laparoscopic repair offers a safe and effective treatment option.
- The necessity of contralateral exploration for asymptomatic patent processus vaginalis is questionable.
Abstract:
Indirect inguinal hernias are the most commonly incarcerated hernias in children, with a higher incidence in low birth weight and premature infants. Contralateral groin exploration to evaluate for a patent processus vaginalis or subclinical hernia is controversial, given that most never progress to clinical hernias. Most indirect inguinal hernias can be reduced nonoperatively. It is recommended to repair them in a timely fashion, even in premature infants. Laparoscopic repair of incarcerated inguinal hernia repair is considered a safe and effective alternative to conventional open herniorrhaphy. Other incarcerated pediatric hernias are extremely rare and may be managed effectively with laparoscopy.