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Modified Marcy repair of large indirect inguinal hernia in infants and children
K Yokomori1, M Ohkura, Y Kitano
1Department of Pediatric Surgery, Japanese Red Cross Medical Center, University of Tokyo Hospital.
Abstract:
Based on a review of operative notes of recurrent inguinal hernia cases from the authors' primary series, a surgical technique modified from the Marcy repair is described. With this technique, emphasis is placed on preservation of the intact internal spermatic fascia and reduction in the size of the internal inguinal ring. Through the inguinal approach, the sleeve-like extension of the internal spermatic fascia is incised longitudinally along the cord and up to the internal ring. The cord structures are dissected off the sac, and as much of the fascial tissue as possible is preserved intact. Both edges of the fascial defect are approximated with an unabsorbable suture; great care is taken to not penetrate the wall of the sac. The same suture is then used for high ligation, via a stay suture placed on the transversalis fascia on the other side of the neck, to reduce the size of the internal ring. The technique can be used in premature babies who have a flimsy, easily torn sac, and in some cases of giant hernia with a widely dilated internal inguinal ring, if the direct wall integrity remains adequate.
Insights
This study presents a modified Marcy repair technique for recurrent inguinal hernias, focusing on preserving spermatic fascia and reducing the internal inguinal ring size. The method is suitable for premature infants and certain giant hernias.
Area of Science:
- Surgical Innovation
- Pediatric Surgery
- Hernia Repair
Background:
- Recurrent inguinal hernias pose surgical challenges.
- Existing repair techniques may have limitations in specific patient populations.
- The Marcy repair is a foundational technique for inguinal hernia repair.
Purpose of the Study:
- To describe a modified Marcy repair technique for recurrent inguinal hernias.
- To emphasize key surgical steps for optimal outcomes.
- To highlight the applicability of the technique in challenging cases.
Main Methods:
- Review of operative notes for recurrent inguinal hernia cases.
- Modification of the standard Marcy repair.
- Focus on preserving internal spermatic fascia and reducing internal inguinal ring size.
- Use of unabsorbable sutures for fascial approximation and high ligation.
Main Results:
- The described technique facilitates preservation of intact internal spermatic fascia.
- Reduction in the internal inguinal ring size is achieved.
- The technique is adaptable for premature infants and certain giant hernias with adequate direct wall integrity.
Conclusions:
- The modified Marcy repair offers a viable approach for recurrent inguinal hernias.
- Emphasis on fascial preservation and ring reduction is crucial.
- This technique expands repair options for complex pediatric inguinal hernia cases.