Surgical Treatment of Inguinal Canal Hernias in Boys: an Analysis of Five Years’ Experience

Introduction. Currently the surgical treatment of inguinal hernias in children is usually a high ligation of the hernia sac without the separation of its distal portion or plastic reconstruction of the inguinal canal. This technique is considered the treatment of choice as it has brought down the incidence of post-operative hernias and testicular atrophy. However, the issues of approach to the selection of a conservative treatment strategy and the role played by instrumental examination methods used to determine indications for surgical treatment remain controversial.

Materials and methods. This paper presents a retrospective analysis of 684 clinical cases followed up at the Yaroslavl Regional Children’s Teaching Hospital. The study included boys aged one month to 17 years who were treated for inguinal and inguinoscrotal hernias in 2011-2015.

Results and discussion. 89 patients (10.3%) were hospitalised with incarcerated inguinal and inguinoscrotal hernias in the period under review. Of these, in 86 patients, when the incarceration lasted under 12 hours, conservative treatment attempts were undertaken. Hernia reduction was achieved without any direct manipulation on the hernia sac in 10 boys (11.6%). Attempts of manual hernia reduction were undertaken in the remaining 56 children (65.1%); these resulted in successful outcomes in 47 patients (83.9%). Emergency surgical repair of incarcerated hernias was performed in 23 cases (3.1%). No patients with incarcerated hernias were older than seven years. 45 out of 183 boys (29.5%) had scrotal oedemas and haematomas in the early post-operative period following planned hernia repair surgeries.

Conclusion. In the majority of patients hospitalised early the conservative hernia reduction approach was effective and resulted in fewer emergency hernia repair surgeries. Ultrasound examination of inguinal canal may be considered as a method of screening for asymptomatic hernias.

1. Esposito C., Escolino M., Turrà F., Roberti A., Cerulo M., Farina A., et al. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg. 2016;25(4):232–40. DOI: 10.1053/j.sempedsurg.2016.05.006

2. Sarin Y.K. Recent advances and controversies in pediatric surgery. Indian J Pediatr. 2017;84(7):529–30. DOI: 10.1007/s12098-017-2361-x

3. Tillig B., Ehrich J., Rolle U. Diversity of service systems in pediatric surgery for fetuses, neonates, infants, children, and adolescents in Europe. J Pediatr. 2018;192:270–1. DOI: 10.1016/j.jpeds.2017.09.051

4. Stalmakhovich V.N., Strashinskiy A.S., Kaygorodova I.N., Li I.B. Results of the use of various methods of endoscopic inguinal herniorrhaphy in children. Russian Journal of pediatrics surgery. 2018;22(3):124– 6 (In Russ.). DOI: 10.18821/1560-9510-2018-22-3-124-126

5. Chang S.J., Chen J.Y., Hsu C.K., Chuang F.C., Yang S.S. The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study. Hernia. 2016;20(4):559–63. DOI: 10.1007/s10029-015-1450-x

6. Abdulhai S.A., Glenn I.C., Ponsky T.A. Incarcerated pediatric hernias. Surg Clin North Am. 2017;97(1):129–45. DOI: 10.1016/j.suc.2016.08.010

7. Kozlov Yu.A., Novozhilov V.A., Rasputin A.A., Kovalkov K.A., Chubko D.M., Baradieva P.Zh., et al. Treatment of inguinal hernias in children: review of laparoscopic techniques, or history of “hooks and needles”. Endoscopic surgery. 2017;23(1):33–43 (In Russ.). DOI: 10.17116/endoskop201723133-43

8. Gubov Yu.P., Blandinsky V.F., Zelenskaya N.A., Sokolov S.V., Bereznyak I.A., Kotova Z.N. Clinical criteria for traumatic inguinal herniotomy in boys. Russian Journal of pediatrics surgery. 2015;19(3):15–9 (In Russ.).

9. Weyhe D. New worldwide guidelines for treatment of inguinal hernia: the most important recommendations from HerniaSurge. Chirurg. 2017;88(7):628. DOI: 10.1007/s00104-017-0386-3

10. Holcomb G.W., Murphy J.P., Ostlie D. Ashcraft’s pediatric surgery. Philadelphia: Elsevier; 2014.

11. Maillet O.P., Garnier S., Dadure C., Bringuier S., Podevin G., Arnaud A., et al. Inguinal hernia in premature boys: should we systematically explore the contralateral side? J Pediatr Surg. 2014;49(9):1419–23. DOI: 10.1016/j.jpedsurg.2014.01.055

12. Crankson S.J., Al Tawil K., Al Namshan M., Al Jadaan S., Baylon B.J., Gieballa M., et al. Management of inguinal hernia in premature infants: 10-year experience. J Indian Assoc Pediatr Surg. 2015;20(1):21–4. DOI: 10.4103/0971-9261.145440

13. Shahnama A., Mehrana P., Hazhirb J., Fatemeha M. Recurrence and complications of pediatric inguinal hernia repair over 5 years. Ann Pediatr Surg. 2013;9(2):58–60. DOI: 10.1097/01.XPS.0000426350.23987.7a

14. Ozdamar M.Y., Karakus O.Z. Testicular ischemia caused by incarcerated inguinal hernia in infants: incidence, conservative treatment procedure, and follow-up. Urol J. 2017;14(4):4030–3. PMID: 28670671

15. Isakov U.F., Dronov A.F. (editors) Pediatric surgery: National guidelines. Moscow: Geotar-Media; 2014 (In Russ.).

16. Amini R., Baker N., Woolridge D.P., Echeverria A.B., Amini A., Adhikari S. Emergency department diagnosis of an ovarian inguinal hernia in an 11-year-old female using point-of-care ultrasound. World J Emerg Med. 2018;9(4):291–3. DOI: 10.5847/wjem.j.1920-8642.2018.04.010

17. Kozlov Y.A., Novozhilov V.A., Baradieva P.Z., Zvonkov D.A., Ochirov C.B. Incarcerated inguinal hernias in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2018;8(1):80–95 (In Russ.). DOI: 10.30946/2219-4061-2018-8-1-80-95

18. Abd-Alrazek M., Alsherbiny H., Mahfouz M., Alsamahy O., Shalaby R., Shams A., et al. Laparoscopic pediatric inguinal hernia repair: a controlled randomized study. J Pediatr Surg. 2017;52(10):1539–44. DOI: 10.1016/j.jpedsurg.2017.07.003

19. Ten Y.V., Boyko A.V., Osetskiy I.G., Ten K.Yu., Elkova D.A. Approaches to the operational treatment of congenital inguinal hernia at the present stage of the development of children’s surgery. Russian Journal of pediatrics surgery. 2018;22(1):28–31 (In Russ.). DOI: 10.18821/15609510-2018-22-1-28-31

20. Akramov N.R., Omarov T.I., Gimadeeva L.R., Galliamova A.I. Male reproductive status after the classical inguinal hernia repair. Kazan Medical Journal. 2014;95(1):7–11 (In Russ.).