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The pathological evaluation of the pediatric inguinal hernia sac
W J Wenner1, M Gutenberg, T Crombleholme
1Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
Insights
Routine pathological evaluation of pediatric hernia sacs provides minimal clinical information. Mandatory tissue submission for these cases may not be necessary, warranting reconsideration of current guidelines.
Area of Science:
- Pediatric Surgery
- Pathology
- Surgical Oncology
Background:
- Current guidelines for pediatric hernia sac evaluation are lacking.
- Some states mandate pathological evaluation of hernia sacs.
- This study addresses the need for evidence-based recommendations.
Purpose of the Study:
- To retrospectively analyze the clinical utility of pathological evaluation of pediatric hernia sacs.
- To determine the impact of hernia sac findings on patient care.
- To inform guidelines regarding routine pathological examination of pediatric hernia sacs.
Main Methods:
- Retrospective review of 8-year pathology reports for pediatric hernia sacs.
- Analysis of 7,924 hernia sac specimens from 6,034 patients.
- Detailed evaluation of specimens with findings beyond 'consistent with hernia sac'.
Main Results:
- Over 95% of specimens were consistent with hernia sac, showing no additional findings.
- Microscopic evaluation was performed on a small subset (534 specimens).
- No patient's care was altered by the pathological findings of the hernia sac.
Conclusions:
- Routine pathological evaluation of pediatric hernia sacs yields limited clinical value.
- Mandatory submission of pediatric hernia sacs for pathological evaluation should be reconsidered.
- Evidence suggests current practices may not be cost-effective or clinically beneficial.
Background:
The College of American Pathologists has suggested that institutions should establish guidelines for the evaluation of the hernia sac. In addition, some states require the submission of this tissue for pathological evaluation. Yet, neither evidence-based guidelines nor published reviews for the evaluation of the pediatric hernia sac are available. Therefore, this retrospective study was conducted to document experience with the evaluation of the pediatric hernia sac.
Methods:
All reports of the evaluation of hernia sacs submitted to the Department of Pathology during an 8-year period were reviewed. The case of any report that differed in any way from "consistent with hernia sac" was evaluated for the effect of the findings on the clinical course.
Results:
A total of 7,924 hernia sacs were submitted on 6,034 patients. Microscopic evaluation was performed on 534. A total of 7,567 (95.4%) submitted specimens on 5,743 patients were "consistent with hernia sac" and demonstrated no other findings. Three hundred fifty-seven specimens contained findings in addition to hernia sac. In no patient did the results of the evaluation have an effect on the patient care.
Conclusions:
There is strong evidence that the routine pathological evaluation of pediatric hernia sacs offers little relevant clinical information. Mandatory tissue submission of hernia sacs should be reconsidered.