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Updated: Jul 14, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Selective anterior annuloplasty during inguinal herniotomy in boys: an approach to further reduce hernia recurrence
Ayman Aljazaeri1, Raghad AlKhashan1, Razan Naif AlRabah1
1From the Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Adding anterior annuloplasty (AAP) to inguinal herniotomy (IH) in high-risk boys significantly reduces hernia recurrence. This novel approach is safe and effective, with minimal other complications. Further controlled trials are recommended.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Hernia Repair
Background:
- Hernia recurrence is a common complication following pediatric inguinal herniotomy (IH).
- A novel approach involving anterior annuloplasty (AAP) during IH for selective high-risk children is presented.
Purpose of the Study:
- To evaluate the initial safety and effectiveness of selective AAP during IH in boys.
- To assess the impact of AAP on hernia recurrence rates in high-risk pediatric patients.
Main Methods:
- Retrospective study at a tertiary care center.
- Included boys under 15 undergoing IH with or without AAP (January 2011-January 2022).
- Compared recurrence risks and postoperative complications between groups.
Main Results:
- Only one recurrence (0.3%) reported across all cases.
- AAP group had significantly younger, more premature patients with higher rates of adhesions and incarcerated hernias.
- High-recurrence risk patients were nearly twice as likely to receive AAP.
Conclusions:
- Selective addition of AAP to conventional IH for high-risk boys is safe and effective.
- This approach reduces overall hernia recurrence without increasing other postoperative complications.
- A prospective, controlled trial with longer follow-up is suggested for stronger conclusions.
Background:
Hernia recurrence is one of the most common complications after inguinal herniotomy (IH) in children. We describe a novel approach that involves adding anterior annuloplasty (AAP) during IH for selective high recurrence-risk children.
Objectives:
Evaluate the initial safety and effectiveness of selective AAP during IH in boys.
Design:
Retrospective SETTING: Tertiary care center.
Patients And Methods:
The study included boys younger than 15 who were selected to undergo either IH with or without AAP between January 2011 and January 2022. The preoperative recurrence risks were compared for the two groups. Cases who underwent other forms of hernia repair were excluded.
Main Outcome Measures:
The frequency of recurrence and other postoperative complications and the distribution of high recurrence-risks.
Sample Size:
315 boys; 143 underwent IH and AAP, while 172 had IH only.
Results:
Among all the cases, only one recurrence was reported (0.3%). Other complications were hydrocele in 29 (9.2%), scrotal hematoma/inflammation in 9 (2.9%), and wound infection in 8 (2.6%), which resolved spontaneously in all cases. Compared to IH only, those selected for an additional AAP were significantly younger (3 [16%] vs. 12 [46%] months, P=.038) and more likely to be premature (35 [24.5%] vs. 15 [8.7%], P<.0001), frequently had extensive cremasteric adhesions (39.2% versus 3.5%, P<.0001) and had a higher rate of incarcerated hernia at presentation (6.3% versus 1.2%, P=.026). The high-recurrence risk group was almost twice as likely to be selected for an additional AAP compared to the low-risk group (143 vs. 75, P<.0001).
Conclusion:
Adding simple AAP to conventional hernia repair for high-recurrence risk boys can be a safe and effective step to reduce the overall risk of recurrence without increasing the incidence of other postoperative complications.
Limitations:
The study lacked a control group of patients to whom selective AAP would not be offered despite a high-recurrence risk. A prospective, controlled trial with a longer follow-up would lead to a stronger conclusion.
