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Close relationship between the short round ligament and the ovarian prolapsed inguinal hernia in female infants
Hisako Kuyama1, Sadashige Uemura2, Atsushi Yoshida2
1Department of Pediatric Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan. hkuyama@med.kawasaki-m.ac.jp.
Insights
In female infants, a short round ligament is linked to ovarian inguinal hernias. This anatomical finding helps explain why ovaries and fallopian tubes are positioned near the hernia opening, particularly with a patent processus vaginalis.
Area of Science:
- Pediatric Surgery
- Anatomy
- Gynecology
Background:
- Inguinal hernias are common in female infants.
- The processus vaginalis (PV) is a potential pathway for herniation.
- The round ligament's role in ovarian positioning relative to inguinal hernias is not fully understood.
Purpose of the Study:
- To investigate the relationship between round ligament length and patent processus vaginalis (PV).
- To test the hypothesis that a short round ligament causes ovarian inguinal hernias in female infants.
Main Methods:
- Laparoscopic surgery was performed on 132 girls with inguinal hernias.
- Ovarian prolapse was diagnosed pre-operatively.
- Internal inguinal ring, PV orifice diameter, and round ligament length were assessed laparoscopically.
Main Results:
- Ovarian inguinal hernias occurred in 17 infants.
- In infants, the round ligament was short, positioning the ovary near the hernia orifice.
- Round ligament length was significantly shorter in cases with an open PV compared to a closed PV, especially in younger girls.
Conclusions:
- The round ligament, derived from the fetal gubernaculum, is shorter in girls with an open PV.
- A short round ligament is a contributing factor to ovarian prolapsed hernias in female infants.
Purpose:
The aim of this study was to clarify the relationship between the length of the round ligament and the presence of a patent processus vaginalis (PV) based on the hypothesis that a short round ligament is the cause of ovarian inguinal hernia in female infants.
Methods:
Between April 2011 and March 2017, 132 girls underwent laparoscopic surgery for inguinal hernia. Before surgery, the presence of ovarian prolapse was diagnosed. We observed the internal inguinal ring laparoscopically and examined the diameter of the PV orifice as well as the round ligament length. Medical records and video records were reviewed to evaluate PV patency and round ligament length.
Results:
Seventeen of the 132 cases had an ovarian inguinal hernia; all of them were infants. In all infants, with or without a prolapsed ovary, the round ligament was short, causing the ovary and fallopian tube to be close to the hernia orifice over the pelvic brim. In girls aged over 12 months, the round ligament lengths on the hernia side, contralateral open PV side, and contralateral closed PV side were 33.0 ± 9.3, 36.8 ± 7.5, and 41.4 ± 8.5 mm, respectively. The round ligament length in open PV was significantly shorter than in the closed PV, but the difference was smaller in older patients.
Conclusion:
The round ligament, which is the female gubernaculum in the fetus, was shorter in the open PV than in the closed PV in younger girls. The short round ligament results in the ovarian prolapsed hernia.
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