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Rare intraoperative findings during the management of pediatric inguinal pathologies: a decade of experience
Mostafa Zain1, Sameh Shehata1, Ahmed Elrouby1
1Pediatric Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Rare intraoperative findings in pediatric inguinal surgery occur in less than 1% of cases. Awareness and advanced techniques are crucial for managing these uncommon anomalies and ensuring optimal patient outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Anatomy
- Medical Diagnostics
Background:
- Pediatric inguinal surgeries are common, addressing conditions like hernias, undescended testes, and hydroceles.
- Rare intraoperative findings and anatomical variations can present challenges during these procedures.
- This study investigates the incidence and management of rare findings in pediatric inguinal surgeries over a decade.
Purpose of the Study:
- To evaluate the incidence of rare intraoperative findings in pediatric inguinal surgery.
- To analyze the management strategies and outcomes for these rare cases.
- To highlight the importance of recognizing and addressing anatomical variations during surgery.
Main Methods:
- Retrospective observational study of pediatric inguinal surgeries (2013-2022).
- Inclusion criteria: patients ≤14 years with complete operative records.
- Rare findings defined as anomalies not typically encountered; independently reviewed by two surgeons.
Main Results:
- Out of 8,756 patients, 69 cases (0.8%) presented rare findings.
- Identified anomalies included Amyand's hernia, looping vas deferens, and complete androgen insensitivity syndrome (CAIS).
- Other rare findings included congenital unilateral absence of the vas deferens (CUAVD) and splenogonadal fusion.
Conclusions:
- Rare findings, though infrequent (<1%), require surgical adaptability and heightened awareness.
- Preoperative imaging and laparoscopic techniques can improve detection and management.
- Enhanced training focusing on rare anomalies is recommended to optimize surgical outcomes.
Background:
Pediatric inguinal surgeries, including procedures for inguinal hernias, undescended testes, and hydroceles, are among the most common surgical interventions in children. While these conditions are well-understood, rare intraoperative findings and anatomical variations can complicate surgical management. This study reviews a decade of experience at a single institution to evaluate the incidence, management, and outcomes of such rare findings.
Methods:
A retrospective observational study was conducted at a tertiary pediatric surgery center in Egypt, analyzing all inguinal surgeries performed between 2013 and 2022. Patients aged ≤14 years with complete operative records were included. Rare findings were defined as anomalies not typically encountered in standard procedures and were independently reviewed by two surgeons. Data were extracted from surgical logs, operative notes, and electronic records.
Results:
Among 8,756 patients (85.5% male, 14.5% female), rare intraoperative findings were identified in 69 cases (0.8%). These included Amyand's hernia (n = 12), looping vas deferens (n = 34), splenogonadal fusion (n = 2), complete androgen insensitivity syndrome (CAIS, n = 7), congenital unilateral absence of the vas deferens (CUAVD, n = 5), crossed ectopic testes (n = 5), ureteroinguinal hernia (n = 1), Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome (n = 1), and encysted hydrocele (n = 1, female). Most anomalies were identified incidentally, with management tailored to preserve function and minimize complications.
Conclusion:
Rare findings in pediatric inguinal surgery, though uncommon (<1%), necessitate surgical adaptability and awareness. Preoperative imaging and laparoscopic techniques enhance detection and management. Training programs should emphasize these anomalies to optimize outcomes.
