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Inguinal Hernia Containing the Uterus in the Pediatric Patient: A Systematic Review
Giulia Brooks1, Silvia Bisoffi1, Calogero Virgone1
1Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padua, Italy.
Insights
Pediatric inguinal uterus hernias are rare, with no consensus on optimal management. Both open and laparoscopic surgical approaches appear effective and safe, though long-term reproductive effects remain unclear.
Area of Science:
- Pediatric Surgery
- Gynecological Surgery
- Medical Diagnostics
Background:
- Inguinal hernia containing the uterus in pediatric patients is exceptionally rare.
- No established guidelines exist for diagnosis, surgical management, or follow-up.
- This condition occurs in patients with normal karyotype and phenotype.
Observation:
- A systematic review analyzed 73 patients from 36 articles, plus one case from the center.
- The condition was most frequently diagnosed in infants (median age 1.5 months).
- Sixty percent of cases were asymptomatic; 37.5% presented with signs of incarcerated hernia.
Findings:
- The uterus and associated adnexa were always involved in the herniation.
- Open surgical approach was more common (56.4%).
- No postoperative complications or recurrences were reported for either open or laparoscopic methods.
Implications:
- Current data are insufficient to determine the optimal surgical approach.
- Long-term reproductive outcomes in asymptomatic patients require further investigation.
- Both open and laparoscopic techniques are viable, safe options for pediatric inguinal uterus hernias.
Background:
Inguinal hernia containing the uterus in pediatric patients with normal karyotype and phenotype is an extremely rare entity, and no consensus is available concerning diagnosis, surgical management, and follow-up.
Methods:
A systematic review according to the Synthesis Without Meta-analysis protocol was conducted. Studies including pediatric female patients with inguinal hernia containing the uterus were searched. Keywords and mesh term searches were conducted (Medline, Scopus, and Web of Science). We additionally reviewed our center's clinical records and found 1 patient with an inguinal uterus hernia that was included in the statistical analysis.
Results:
Thirty-six articles and 73 patients were considered for this analysis. The median gestational age at birth was 36 weeks. The inguinal mass was first noticed at the median age of 1.5 months (0-18 months), on the left side in 61% (on the right in 16, 39%). Sixty percent of patients had no associated symptoms or signs; 37.5% showed symptoms and signs of an incarcerated hernia. Median age at surgery was 2 months (1-72 months). In all patients, one or both adnexa herniated with the uterus. An open approach was more frequently used (56.4%). Contralateral duct exploration and ligation was performed in 7 patients (24.1%). No postoperative complications or recurrence have been described.
Conclusions:
The data obtained do not allow us to draw univocal conclusions on which is the best management in these patients. It is still unclear if an elective approach in an asymptomatic patient might bear long-term consequences on reproductive functions. No surgical technique proved to be superior to others, but both the open and laparoscopic approaches seem to be effective without postoperative complications or recurrence.
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