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Is It Mandatory To Ligate Sac In Emergency Herniotomy In Paediatric Age Group? A Prospective Cohort
Zainab Haj1, Shawana Asad1, Zaheer Qureshi1
1Department of Surgery, Ayub Medical and Teaching Hospital, Abbottabad, Pakistan.
Insights
In pediatric emergency inguinal hernia repair, leaving the hernia sac open during herniotomy is safe and avoids an unnecessary surgical step. This approach showed comparable complication rates to sac ligation, making it a preferable option.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Hernia Repair
Background:
- Herniotomy is the standard treatment for pediatric inguinal hernias.
- Surgeons debate the necessity of hernia sac ligation during the procedure.
- This study investigated leaving the sac open to assess early recurrence rates.
Purpose of the Study:
- To evaluate the safety and efficacy of performing pediatric herniotomy without ligating the hernia sac in emergency cases.
- To compare early recurrence and complication rates between open-sac and ligated-sac techniques.
Main Methods:
- A quasi-experimental study involving 151 children (birth to 12 years) undergoing emergency inguinal herniotomy.
- Patients were randomly assigned to either leaving the sac open (experimental group) or high ligation (control group).
- Follow-up assessments for recurrence and complications occurred at 10 days, and 1, 3, and 6 months post-surgery.
Main Results:
- No early recurrence of inguinal hernia was observed in either group.
- The experimental group (open sac) had scrotal hematoma (6.7%) and scrotal edema (6.7%).
- The control group (ligated sac) showed similar complication rates: hematoma (5.1%) and scrotal edema (6.6%).
Conclusions:
- Herniotomy without sac ligation in children is a safe procedure in emergency settings.
- Sac ligation is an additional step that does not appear to reduce early complications or recurrence.
- Performing herniotomy without sac ligation is a safe and preferable approach for pediatric emergency inguinal hernia repair.
Background:
Herniotomy is standard treatment for inguinal hernia in children. Paediatric surgeons remain divided on whether ligation of sac is mandatory. In our study, we left the sac open to see early recurrence.
Methods:
This quasi=experimental study, done in emergency cases, was sequel to our previous study done in elective cases. It was carried out at surgical unit C of Ayub Hospital Complex, Abbottabad, from Jan 2016 to June 2020. Children from birth to 12 years of age were randomly divided into two groups. In group I (experimental), sacs were cut high up and left open during herniotomy while in group II (control), high ligation of hernia sac was done. Follow up was scheduled for day 10 and 1, 3 and 6 months. Patients were assessed for early recurrence and other complications.
Results:
A total of 151 emergency inguinal herniotomies were done including 147 males (97.4%) and 4 females (2.6%). 136 sacs (90.1%) were ligated with vicryl 3/0 or 4/0 while 15 sacs (9.9%) were left open. We did not find early recurrence, but found 1 case of scrotal hematoma (n=1/15) (6.7%) and 1 case of scrotal oedema (n=1/15) (6.7%) in the experimental group. In control group, complications were similar with 7 cases of hematoma (n=7/136) (5.1%) and 9 cases of scrotal oedema (n=9/136) (6.6%).
Conclusions:
Complications are comparable in herniotomy with or without ligation of sac but ligation adds an extra step. Herniotomy without sac ligation in children is safe and preferable in emergency setup.
