How are simple inguinal hernias repaired in children?

Updated: Jul 23, 2019
  • Author: Assar A Rather, MBBS, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

A simple inguinal hernia repair is possible in children because of the smaller size, better muscle tone in the canal, and rapid recuperation. Excision of the hernial sac (processus vaginalis) is usually sufficient, with little need for prosthetic repair of an attenuated internal ring or posterior wall of the inguinal canal. Either preincisional injection of the incision site or a caudal block is preferable to no preincisional therapy. [34]

A small incision is made just superior and lateral to the pubic tubercle in the suprapubic skin crease, centering the operative field near the internal ring. The external oblique aponeurosis is incised in the direction of its fibers, or the internal and external rings are transposed by laterally retracting the latter. Tugging on the testis helps visualize cord structures. The glistening white hernia sac often bulges up amid the cord. The sac, located anteromedial to the cord, is elevated from the floor and carefully dissected free from the vas deferens and testicular vessels.

Short hernia sacs are freed to the internal ring, but long sacs are often best divided. Proximal dissection to the internal ring should extend until preperitoneal fat is visible circumferentially. Twisting the sac before ligation provides strength and narrows the internal ring. The sac is ligated at its base. Because of occasional postoperative “spitting” of a nonabsorbable (eg, silk) suture, synthetic sutures are used for sac ligation.


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