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Ultrasound-guided pediatric inguinal hernia repair
Kevin N Johnson1, Cory N Criss1, Ronald B Hirschl1
1Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's and Von Voigtlander Women's Hospital, Ann Arbor, MI, USA 48109.
Insights
Ultrasound-guided inguinal hernia repair is safe and feasible in female pediatric patients, showing no recurrences or injuries. Further research will compare this technique to others and explore its use without general anesthesia.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Medical Imaging
Background:
- Inguinal hernias are common pediatric surgical conditions.
- Current repairs involve open or laparoscopic high ligation of the hernia sac.
- Ultrasound is used for identifying hernia contents in children.
Purpose of the Study:
- To assess the feasibility of ultrasound-guided high ligation of the hernia sac in pediatric patients.
- To evaluate the safety and efficacy of this novel approach.
Main Methods:
- Retrospective review of female pediatric patients undergoing ultrasound-guided inguinal hernia repair (2017-2018).
- Evaluation of pre-operative, intra-operative, and post-operative outcomes.
- Laparoscopy used for repair assessment and contralateral hernia screening; males excluded due to risk to vas deferens and vessels.
Main Results:
- 10 patients with 13 hernias underwent the procedure.
- One patient required conversion to laparoscopic repair.
- No inappropriate repairs, missed contralateral hernias, vascular injuries, or surrounding structure damage were reported.
- Zero hernia recurrences observed during the study period.
Conclusions:
- Ultrasound-guided inguinal hernia repair is safe and feasible in female pediatric patients.
- Further studies are needed to compare with existing techniques and evaluate long-term recurrence.
- Potential for non-general anesthetic application warrants further investigation.
Purpose:
Inguinal hernias are amongst the most common surgical conditions in children. Typically, these repairs are performed through an open or laparoscopic approach, using a high ligation of the hernia sac. The use of ultrasound has been described in identifying and evaluating hernia contents in children. Our goal was to determine if ultrasound guidance could be used to perform a high ligation of the hernia sac in pediatric patients.
Methods:
Following IRB approval, a retrospective review of all female patients at a single center undergoing ultrasound guided inguinal hernia repair between 2017 and 2018 was performed. Pre-operative characteristics, intra-operative outcomes, and post-operative outcomes were all evaluated. Laparoscopy was used to evaluate the repair and evaluate for a contralateral hernia. Male patients did not undergo ultrasound inguinal hernia repair to avoid damage to the vas deferens and vessels.
Results:
A total of 10 patients with 13 hernias total were found during the study period. A total of one patient was converted to a laparoscopic repair. No patients were found to have an inappropriate repair or a missed contralateral hernia, and there were no vascular injuries or injuries to surrounding structures. No patients had a hernia recurrence during the study period.
Conclusion:
This study demonstrates the safety and feasibility of ultrasound guided inguinal hernia repairs in female pediatric patients. Further study is needed to compare these repairs to existing techniques, evaluate for recurrences over time, and evaluate if these repairs can be performed without general anesthetic in some patients.
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