• Advances in pediatric surgery
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• v.4 no.1
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• pp.48-54
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• 1998

A total of 335 pediatric inguinal hernias were analyzed at the Department of General Surgery, St. Benedict Hospital, for last 10 years (1986 to 1995). Male patients were predominant(2.25 : 1), and 78.2 % were under 2 years of age. Right side was 1.63 times more frequent than the left. Among the 19 cases of incarcerated hernias, 84 % could be safely reduced preoperatively. Twelve cases(3.6 %) were repaired by the Bassini procedure and 21 cases(6.3 %) by internal ring repair. The majority (90.1 %) however did not require a posterior wall reconstruction. Bilaterality was found in 25 cases(7.5 %), and in 8 cases(2.4 %) subsequent contralateral hernia developed after primary ipsilateral repair. Postoperative complication occurred in 15 cases(4.5 %); scrotal seroma and/or hematoma(3%), wound infection(0.6 %), and pneumonia(0.9 %). In order to reduce the incidents of complications, children with inguinal hernias should be treated by a pediatric surgeon.

• Advances in pediatric surgery
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• v.8 no.1
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• pp.16-22
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• 2002

Between March 1999 and January 2000, 82 boys with the diagnosis of inguinal hernias (12 bilateral and 70 unilateral hernias), underwent Ultrasound (US) examination of both sides of the groin, a total of 164 inguinal imaging prior to surgery. The patients ages ranged from 3 days to 12 years with a mean of 32.6 months. Ninty four examinations were on the clinically symptomatic side and 70 were on the asymptomatic side. The US criteria for the diagnosis of an inguinal hernia were as follows: 1) visceral hernia, the presence of bowel loops, or omentum in the inguinal canal, 2) communicating hydrocele, the presence of fluid in the processus vaginalis, 3) widening of patent processus vaginalis at the level of internal inguinal ring. The width of patent processus vaginalis at the level of internal inguinal ring over 4 mm is considered an occult hernia. Among the 94 symptomatic groins, US findings showed 31 (33%) visceral hernias, 18 (19%) communicating hydroceles, and 38 (41%) widening of the internal inguinal ring, and 7 (7%) groins without abnormalities. In 70 asymptomatic groins, there were 4 (6%) visceral hernias, 5 (7%) communicating hydroceles, 11 (16%) widening of the internal inguinal ring, and 50 (70%) groins without abnormalities. Among the 70 asymptomatic groins there were US abnormalities in 20 (28%). One hundred and seven groins with positive US findings were surgically explored. Among 107 operated sites, the operative findings were compatible with the US diagnosis in 104, a sensitivity for US of 97.2%. In patients with US findings of widening of internal inguinal ring (>4 mm), there was patent processus vaginalis in 36 out of 38 symptomatic groins and 10 of 11 asymptomatic groins. The sensitivity of US to the operative findings in widening of internal inguinal ring was 93.8%. For visceral hernia and communicating hydrocele, the sensitivity of positive US findings was 100%. Ultrasonography for inguinal hernias appears to be a rapid, reliable, and noninvasive screening diagnostic tool with high positive specificity. Therefore, we recommend the use of US as a routine diagnostic tool in pediatric patients with inguinal hernias and hydroceles.

• Journal of Chest Surgery
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• v.45 no.6
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• pp.415-417
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• 2012

The development of Morgagni hernias is related to malformations of the embryologic septum transversum after failure of the sternal and costal fibrotendinous elements of the diaphragm to fuse. The overall incidence of Morgagni hernias among all congenital diaphragmatic defects is 3% to 4%. Inguinal hernias are the most common hernias in males and females (25% and 2%, respectively). An inguinal hernia is defined as a protrusion of the abdominal cavity contents through the inguinal canal. The combination of Morgagni and inguinal hernias is rare, and treatment using laparoscopic surgery has not been previously reported. This case presents a one-stage laparoscopic repair of Morgagni and inguinal hernias in a 2-month-old male.

• Advances in pediatric surgery
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• v.12 no.1
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• pp.1-10
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• 2006

Recent advances in neonatal management have resulted in a dramatic increase in survival of very low birth weight infants. These critically ill infants, however, continue to pose significant challenges in management and ethics. There is little information on the outcome of the micropremie (birth weight less than 800 g) that require surgery. The records of 171 micropremies treated over a 15 year period (beginning in 1989) at Asan Medical Center was reviewed retrospectively. Forty-one (24.0 %) infants required surgical interventions by pediatric surgeons. There were 90 boys and 81 girls. The smallest infant, weighed 396g at birth, had esophageal atresia and died before surgery. The smallest survivor, birth weight 645 g, received anenterostomy for necrotizing enterocolitis at the weight of 590 g. The gestational age of the group rangedfrom 21 to 36 weeks. The most common surgical problem was inguinal hernia. There were 20 inguinal hernias, and repairs were performed on17 infants. Excluding 2 cases, hernia repair was performed at the time of discharge. There was only one recurrence of adirect inguinal hernia. Necrotizing enterocolitis developed in 17 patients, 11 were operated upon, two had peritoneal drainages, and 9 had enterostomies. Five of 11 surgical infants died after operation and three of the nonsurgical infants died of various complications. Although micropremies have potentially high risks of serious complications and death, the outcome can improve with careful surgical observation and judgment.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.155-166
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• 2006

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.203-207
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• 2007

Inguinal hernia repair can result in paresthesia and/or pain in the inguinal region. Pharmacological and surgical management often yield inconsistent results associated with considerable risks and side effects. Radiofrequency thermocoagulation (RF) is a neuro-destructive treatment for severe pain, but associated with hypoesthesia, neuritis-like reactions, and occasional neuroma formation. Pulsed radiofrequency (PRF), unlike RF, delivers high intensity currents in pulses, is non-neurodestructive, and therefore less painful, without the potential complications. Here we report on PRF in chronic postoperative inguinal pain. A 23-year-old male who received right inguinal hernia repair and complained of right sided groin pain for approximately 10 years underwent PRF at the L1 and L2 dorsal root ganglia (DRG). He then reported a decrease in pain from 80-90/100 mm to 15-30/100 mm on a visual analogue scale (VAS), which lasted for twelve months.

• Advances in pediatric surgery
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• v.13 no.2
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• pp.194-202
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• 2007

It is known that pediatric inguinal hernia is caused by the incomplete closure of processus vaginalis (PV). In the case of unilateral hernia, possibile contralateral patent PV should be considered because of its delayed appearance as well as its risk of incarceration. Direct visualization of patent PV could be done by contralateral exploration or by indirect exploration through the ipsilateral opening site of the affected hernia assisted with laparoscope. A patient group (321 persons) to whom laparoscopy was not performed from March 2000 to March 2003 was analyzed and compared with a patient group (280 persons) to whom laparoscopy was performed from April 2003 to September 2005. With all 601 patients, the sex ratio (male/female) of patients was 3.8:1. The side distribution was 57.7% in the right, 32.1% in the left and 10.1% in bilateral. There was no difference of sex and side distribution between before and after laparosopy adoption. We did not find an age correlation in natural closure of the residual PV of the peritoneum. Contralateral hernia developed in 14 persons (2.5%) after the operation of unilateral inguinal hernia before laparoscope adoption. But no contralateral hernia developed after April 2003 with laparoscopy. We think that if we use laparoscopy, being a safe and accurate method, to check whether the contralateral residual PV is opened or closed, possible future contralateral operation can be avoided.

• Health Policy and Management
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• v.14 no.2
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• pp.138-162
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• 2004

This study was performed to investigate small area variation in rates of three common surgeries in general surgery department across 156 small areas. Three surgery rates were analyzed; Anal and/or stomal procedures, inguinal and/or femoral hernia procedures, appendectomy. Methods: We used health insurance claims data and the number of patients were 13,845, 2,154 and 7,151 persons respectively. Surgery rates were directly standardized with age and sex and logistic regression was used to analyze surgery rates. Results: Mapping of the surgery rates, there was small area variation in anal and/or stomal procedures. The clinic which was located in more competitive market and chose DRG payment system tends to do more anal and/or stomal procedures. There was no factor except DRG bed rates had effect on rate of inguinal and/or femoral hernia procedures. Conclusions: Findings of this study will contribute to developing investigation method on small area variation and policy to reduce the variation such as developing evidence based medical practice guideline.

• Journal of Veterinary Clinics
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• v.18 no.4
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• pp.469-473
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• 2001

A 12-year-old bitch, Yorkshire terrier, was admitted to the Chungbuk National University animal hospital with draining from mammary masses in the left and right mammary glands. She was involved in the mammary masses, suffering bilateral inguinal hernia. Physical examination during the hospitalization demonstrated the masses in right (3 cm) and left (1.5 cm) mammary glands. Blood pool images didn\`t show the subtle increase in blood flow to the inguinal hernia, and the increase of radionuclide distribution to the mammary gland on the soft tissue phase. However, delayed bone images showed a very focal lesion in the right mammary gland. These findings were confirmed on a subsequent biopsy, which also revealed adenocarcinoma with areas of malignant new bone formation. We present a case of primary mammary adenocarcinoma with $^{99m}Tc-MDP$ activity relative to normal bone. Tumor in the bitch demonstrates malignant new bone formation as the likely mechanism for the marked radiotracer avidity.

• Advances in pediatric surgery
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• v.1 no.1
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• pp.18-26
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• 1995

For the prevention of later contralateral hernia as well as unnecessary contralateral exploration in pediatric patients with unilateral inguinal hernias, a reasonable indication of contralateral exploration is required. To examine the contralateral positivity, a prospective selective contralateral exploration has been performed by the author from Sept. 1985 to Dec. 1993, at Pediatric Surgical Section of the Department of Surgery, Kangnam St. Mary's Hospital, Catholic University Medical College. Among the total 1200 cases of pediatric inguinal hernias, 580 cases of contralateral side were explored at hernia operations, by the indications as; male with infant onset, 2)female of all age, 3)prematurity, 4)profuse ascites due to cirrhosis, nephrotic syndrome, and ventriculoperitoneal shunt, and 5)remarkable silk sign. Overall positive rate was 71.4%, and positive rates of each indication were 80.7%, 70.4%, 73.1%, 66.7%, and 72.0%, respectively. Right side hernia showed 67.0%, left s ide 75.7%, and positive familial history 71.8% of contralateral positivities. In male, getting older revealed lower positive rates and the rate suddenly dropped after 12 years of age. Birth order, mother's age at delivery, postmaturity did not show any significant differences between the rates. Recurrence was seen in 3(0.5%) ipsilateral and 2(0.3%) contralateral, both of which were negative esplorations on previons operations. Overall complication rate was 3.8%, including 1 infection, 14 fluid or blood accumulation, 5 edemas, 3 temporary testicular edemas, 2 persisting fevers, 2 enures is and one delayed recovery from anesthesia. Among 38 cases with contralateral hernias developed after unilateral surgery by authors(6 cases) or surgeons in other institutions, 14 were males with infant onset, 4 were prematurities and 9 were females. Therefore, 27(71.7%) cases were originally under the contralateral exploration indications. The primary site of the hermia was right in 25 and left in 13. With above results, the following indications for contralateral exploration could be suggested ; 1)under one year of age, both sex, 2)prematurity, 3) remarkable silk sign, 4)in the double checked suspicions among males with infant onset, all age females, ascites, left hernia and familial history. After 12 years of age, exploration is not required. Considering complications, contralateral explorations could be considered only in the following situations; 1)expert, experienced pediatric surgeon, 2)experienced pediatric anesthesiologist, 3)operations could be done smoothly in an hour, 4)good general condition of the patient.