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Comparison of Ferguson and Gross herniotomy with Mitchell Banks' herniotomy in boys older than two years
Hafiz Mahmood Ahmad1, Fatima Naumeri2, Usama Saud3
1Dr. Hafiz Mahmood Ahmad, MBBS. Department of Pediatric Surgery, King Edward Medical University/Mayo Hospital Lahore, Pakistan.
Insights
Mitchell-Banks
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Hernia Repair
Background:
- Inguinal herniotomy techniques differ based on patient age.
- Mitchell-Banks' Herniotomy (MBH) is typically for younger children, while Ferguson and Gross Herniotomy (FGH) is for older children.
- A comparison of MBH and FGH for recurrence in older boys is warranted.
Purpose of the Study:
- To compare the recurrence rates of Mitchell-Banks' Herniotomy (MBH) and Ferguson and Gross Herniotomy (FGH).
- To evaluate surgical outcomes in boys older than two years undergoing inguinal hernia repair.
Main Methods:
- A randomized controlled trial involving 260 boys aged 2-14 years with inguinal hernia.
- Participants were randomly assigned to undergo either MBH (Group-A) or FGH (Group-B).
- Recurrence was assessed at 1 week and 6 months post-surgery.
Main Results:
- Recurrence occurred in 0.8% of patients in the MBH group versus 6.2% in the FGH group (p=0.018).
- MBH had a longer mean operating time (26.65 min) compared to FGH (15.92 min).
- Scrotal edema was more frequent in the MBH group (29.2%) than the FGH group (5.4%).
Conclusions:
- Mitchell-Banks' Herniotomy demonstrates a significantly lower recurrence rate compared to Ferguson and Gross Herniotomy in boys over two years old.
- MBH may be a more effective technique for reducing hernia recurrence in this age group, despite longer operating times.
Background & Objective:
In children younger than two years, most surgeons perform the inguinal herniotomy superficially through the external ring, a technique known as Mitchell-Banks' Herniotomy (MBH) while in older children, commonly Ferguson and Gross Herniotomy (FGH) is performed which involves opening of inguinal canal. Our aim was to compare the FGH and MBH in terms of recurrence in boys with inguinal hernia.
Methods:
Boys with inguinal hernia presenting to Pediatric Surgery, Mayo Hospital Lahore from Dec 2016 to January 2018 were included in the study, if older than two years and younger than 14 years and without palpable deep ring (2 cm or more in width) or strangulation of inguinal hernia or malnutrition. They were randomly allocated in 2 groups after obtaining informed consent from parents, and underwent MBH (Group-A) and FGH (Group-B). Children were called for follow up after 1 week and at 6 months to assess for recurrence.
Results:
Total 260 patients with inguinal hernia were enrolled (NCT: 03392636). The mean age of boys in Group-A was 5.2±3.0 years and in Group-B was 5.9±3.1 years. Mean operating time in Group-A (26.65±3.22 minutes) was longer than Group-B (15.92±4.22 minutes), and scrotal oedema was noted in 38 (29.2%) cases in Group-A, while 7 (5.4%) cases in Group-B. Testicular atrophy was noted in one patient of Group-B. Recurrence occurred in 1(0.8%) patient in Group-A, and in 8(6.2%) patients in Group-B (p-value 0.018).
Conclusion:
Mitchell-Banks' herniotomy has lower recurrence rate than Ferguson and Gross Herniotomy in boys older than two years.
