• Advances in pediatric surgery
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• 제17권1호
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• pp.58-64
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• 2011

Minimally invasive techniques for pediatric inguinal hernia repair have been evolving in recent years. We applied the laparoscopic method to repair pediatric inguinal hernia using the techniques of sac transection and intra-corporeal ligation. Between November 2008 and August 2010, 67 pediatric patients (47 boys and 20 girls) with inguinal hernias were included in this study. Postoperative activities, pain, and complication were checked prospectively at regular follow-up. One patient presented with clinically bilateral hernia, and three patients had metachronous hernias. Thirty-two cases out of 63 patients with unilateral hernias had a patent processus vaginalis on the contralateral side. Mean operation time was $35{\pm}11.4$ minutes for unilateral hernias and $43{\pm}11$ minutes for bilateral hernias. There were no intra-operative complications. One patient had a small hematoma on the groin postoperatively, which subsided spontaneously in a week. Recurrence and metachronous hernia were not found at follow up. In summary, laparoscopic inguinal repair in children is safe, easy to perform and has an additional advantage of contralateral exploration. Further studies should include long term follow-up.

• Advances in pediatric surgery
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• 제8권2호
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• pp.126-132
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• 2002

Inguinal hernia is a major surgical disease in pediatric surgery, occurring in 3.5% to 5% of all mature newborns and 9% to 11% of all premature babies. The objective of this study is to analyze the predisposing factors in association with recurrences of inguinal hernias in infants and children. In the period from January 1995 to September 2001, 1,575 infants and children who had primary inguinal hernias or recurrent inguinal hernias operated on at the Department of Pediatric Surgery at Seoul National University Hospital were evaluated retrospectively. We evaluated the data by medical records and by telephone interview. The sex, age, location of hernia, comorbidity, prematurity, incarceration, interval to operation after incarceration, postoperative complications were analyzed as predisposing factors in associated with hernia recurrence. Operative findings of recurrent inguinal hernia were reviewed. The data were statistically analyzed with Pearson Chi-Square test and Fisher-exact test. A total of eighteen (1.14%) out of 1,575 patients underwent an operation due to recurrent inguinal hernia. In 5 (27.8%) out of 18 recurred patients, institution of the primary herniorrhaphy was our hospital and in the other 13 (72.2%) was outside hospital. No impact on the development of recurrences was seen for sex, age, interval to operation after incarceration, and postoperative complications. The significant predisposing factors of recurrent inguinal hernias were left inguinal hernias (p=0.002), comorbidity (p=0.002), prematurity (p=0.006), incarceration (p=0.017) and technical error of first herniorrhaphy. We expect that knowledge for predisposing factors of recurrent inguinal hernias and experienced skill of pediatric surgeons will decrease recurrence rate in primary inguinal hernia.

• Advances in pediatric surgery
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• 제15권2호
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• pp.149-156
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• 2009

Contralateral groin exploration (CGE) in children with unilateral inguinal hernia remains controversial. Between January 2002 and December 2007, 1967 pediatric patients with inguinal hernia were treated by two surgeons with different criteria of CGE (group A; boys younger than 2 years, older boys prematurely delivered, and all girls, B; birth weight lower than 2 kg with inguinal hernia presentation within 6 months after birth, and suspicious physical findings) at Samsung medical center. Patient's age, sex, body weight, diagnosis, and metachronous contralateral inguinal hernia (MIH) incidence were analyzed retrospectively. Among 895 patients in group A, CGE was performed in 460 patients (66.4 %) and MIH incidence was 1.7 %. In group B, 31 patients (3.5 %) had CGE among 1072 patients, and MIH incidence was 4.2 %. The average hospital costs of group A and B were 763,956 won and 500,708 won, respectively. The CGE criteria of group B had advantage in total hospital cost. The primary site and the age at presentation had a signiticant effect on the incidence of MIH. But MIH incidence was low and the more contralateral explorations lead to increase of total costs. Therefore, routine contralateral groin exploration and surgery for a patent processus vaginalis could not be justified.

• Advances in pediatric surgery
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• 제9권1호
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• pp.35-40
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• 2003

Inguinal hernia is the most frequent problem requiring surgery in children. Moreover, subsequent contralateral occurrence after repair of the symptomatic unilateral inguinal hernia(UIH) is not rare, This study is to evaluate the diagnostic value of inguinal ultrasonography (IUS) for potential bilateral inguinal hernia (BIH). A prospective study was performed for preschool children less than 6 years of age who were diagnosed as UIH from July 1999 to December 2000. We selected 58 cases with potential BIH, based on the past history, such as prematurity, ventriculo peritoneal shunt, family history of BIH. hernia on the left side (LIH), age below 2, female, and contralateral positive silk glove sign on the physical examination, Screening with IUS and bilateral surgical exploration were applied on these cases. Forty-seven cases were males (81.0%) and 11 cases were females (19.0%). Thirty four were infants. Symptomatic right inguinal hernia (RIH) were 28 (48.3%), and LIH were 30 cases (51.7%). Six cases had no evidence of contralateral patent process vaginalis (PPV) by IUS but showed contralateral PPV by operation. Two cases were suspicious to contralateral PPV under IUS, but operative findings were negative. Fifty cases showed contralateral PPV by IUS as well as operation. The detection rate of contralateral PPV under IUS was 86.2%. The preoperative IUS may reduce contralateral exploration.

• Advances in pediatric surgery
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• 제9권2호
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• pp.89-93
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• 2003

A lipomatous lesion of the cord is an accidentally encountered structure during the operative repair of inguinal hernia. This lesion has been reported as a lipoma of the cord in adults. However, there is only a limited number of reports in the pediatric age group. To evaluate the prevalence of this lesion in children and in order to review the surgical signiticancies, 600 hernia operations in 411 children during a period of 4 years from January, 2000 to December, 2003 in the Division of Pediatric Surgery, Department of Surgery, the Catholic University of Korea, were included in this study. There was a total of 31 (5.2 %) lipomatous lesions in 25 (6.1 %) cases; 3 cases in infants, 17 between 1 to 4 years, and 5 above 5 years of age. Male was more prevalent (male to female ratio 14:11). The laterality of clinical hernia with the lesions was 10 in the right, 13 in the left and 2 in both sides. The patients with ipsilateral lesions to the hernia were 14, contralateral in 5 and bilateral in 6 cases. Excluding 1 case of bilateral lesions in bilateral hernia, 10 lesions were contralateral to the clinical hernias. In 1 case, lipomatous lesion was the sole finding with nonsignificant patent processus vaginalis. Every lesion was suture ligated and resected with gentle traction of the dissected hernia sac. It has not been clearly defined whether the lesion is a stopper or a provocator of the hernia development. However, removal is highly recommended to make a differential diagnosis from the recurrent inguinal hernia in future. The term "lipomatous lesion" seems to be pathologically accurate and must be differentiate from the true lipomas.

• Advances in pediatric surgery
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• 제20권2호
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• pp.23-27
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• 2014

Purpose: Laparoscopic hernia repair in children is still controversial. The aim of this study was to report our long-term results of the laparoscopic hernia technique, which is based on the same surgical principles as conventional open herniotomy. Methods: Five hundred fourteen pediatric patients with inguinal hernia were included in this study under informed consent. All patients underwent a laparoscopic technique of sac transection and intracorporeal ligation. The asymptomatic contralateral inguinal ring was routinely explored and repaired if a patient had patent processus vaginalis on the contralateral side. Patients were prospectively followed for 5 years. Those who were lost to follow-up were excluded from the study. Perioperative complications and recurrences were evaluated. Results: The mean follow-up period was 29 months. Mean operation time was 27.5 minutes. Forty one percent of the patients had contralateral patent processus vaginalis. Only one hernia recurred (0.19%). We had one case of contralateral metachronous hernia (0.21%) during follow-up period. Conclusion: The long-term follow-up results of our study revealed that laparoscopic hernia sac transection and ligation can be a safe and effective alternative for conventional herniorraphy.

• 대한한방소아과학회지
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• 제34권2호
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• pp.40-56
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• 2020

Objectives The purpose of this study is to analyze recent clinical studies on traditional Chinese medicine (TCM) treatment for pediatric inguinal hernia and pediatric rectal prolapse in China, and to seek better methods to treat and to study for Inguinal hernia and Rectal prolapse in Korea. Methods We searched the clinical studies from the China National Knowledge Infrastructure (CNKI) that were published between January 2000 to February 2020 by key words '疝气', '直腸脫出', '直腸脫垂', '脫肛', '小腸疝', '腹股溝疝', '儿童', '小儿', '少儿', '幼年', '治療', '中医治療', '中藥', '中医藥', '顆粒', '膠囊', '自擬', '湯', '丸', '散', '方'. We analyzed the literatures in regards to the treatment methods and results. Results Among the 193 searched studies, 10 randomized controlled trials were selected and analyzed. In most of the studies, the effectiveness of the traditional Chinese medicine (TCM) treatment on inguinal hernia and rectal prolapse was significantly high. Conclusions Based on the results of the clinical studies from China, use of the TCM for the treatment of inguinal hernia and rectal prolapse has been shown to be effective in relieving symptoms. Also, based on the result of this study, it will be possible to widen the scope of the TCM treatment on inguinal hernia and rectal prolapse. Additional clinical studies and experimental studies are needed to be performed to solidify these findings. The TCM has been shown as an effective treatment for pediatrics as well. These research results can be utilized in other clinical studies and in treatment.

• Advances in pediatric surgery
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• 제15권1호
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• pp.44-51
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• 2009

This study is a retrospective analysis of 1244 cases of the inguinal hernia in children under the age of fifteen years who were operated at the department of pediatric surgery, Inje University Busan Paik Hospital from March, 1997 to February, 2007. The ratio of male to female was 3.6:1. The type of hernia was indirect in all of the cases. The hernia was on the right side in 656 cases (53.9 %), left side in 467 cases (37.5 %), and bilateral in 121 cases (9.7 %). The hernia presented most frequently in infants under age 12 months; 364 cases (29.2 %). Fifty-nine cases (21.7 %) were in female and 305 cases (31.3 %) in male. There were 428 cases (33.6 %) in 1-3 years age group, 295 cases (23.7 %) in 4-6 years, 112 cases (9.0 %) in 7-9 years, 39 cases (3.1 %) in 10-12 years and 16 (1.2 %) in 13-15 years. The content of hernia sac was small bowel (59 %), omentum (31 %) in males and the ovary and tube (54 %) and small bowel (26 %) in female. The incidence of combined operation at the time was 3.2 %, and consisting of orchiopexy (67.5 %), frenulotomy (12.5 %), appendectomy (10 %), circumcision (5 %), and fistulotomy (5%). The incidence of combined disease was 2.8 % and consisting of undescended testis, Hirschsprung's disease, idiopathic hypertrophic pyloric stenosis, imperforate anus, and congenital heart disease. After unilateral inguinal hernia repairs, contralateral hernias developed in 34 patients. The laterality of the primary site of hernias were left in 19 cases (55.8 %), and right 15 cases (44.1 %). The 936 cases (75.2 %) were operated under general anesthesia; Mask bagging 663 cases (53.2 %), endotrachea intubation 257 cases (20.6 %), and laryngeal mask 16 cases (1.2 %). The remainder 308 cases (24.7 %) were operated under regional caudal anesthesia.

• Advances in pediatric surgery
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• 제1권2호
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• pp.107-114
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• 1995

Three hundred and twenty-seven patients of 2,046 inguinal hernia cases Primarily repaired at Hanyang University Hospital had the history of incarceration or presented as incarcerated inguinal hernia on admission. Incidence of incarceration of all male hernias was 14.2%(234 patients) and 22.7%(93 patients) of all female cases. Incarceration occurred in 17.3% of all right hernia cases and in 13.7% of all left hernia cases. The incarceration occurred 52.6% of the hernia patients in the first month of life, 27.3% in the first year, 26.7% in the second year and 7.8% after 2 years of age. Strangulated inguinal hernia occurred in 8 patients: five patients had ovaries involved, two patients intestines, and one patient omentum. Emergency operations were performed on 66 patients(20.2%) because incarcerated hernia could not be reduced by taxis. At the time of operation, the hernia sacs were empty in 140 of 327 patients and the remainders contained omentum(50), small intestine (44), appendix and/or cecum(28), sigmoid colon(2), ovary and/or tube(66), and omental cyst(1). An elective hernia repair should be performed promptly after presentation of the hernia, especially before 2 years of life because of high incidence of incarceration. In this study, of 327 incarcerated hernia, 187 patients(57.2%) did not have prior history of incarceration and incarceration developed more than 7 days after hernia onset in 95.6%. If the hernia repairs had been performed within 7 days after hernia onset, about half of the incarceration might have been prevented.

• Advances in pediatric surgery
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• 제19권2호
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• pp.145-149
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• 2013

전복막지방 탈출로 인한 합병증은 소아에서 매우 드물며 서혜부 탈장과의 감별이 어렵다. 저자들은 술 전 초음파에서 대망 지방을 포함하고 있는 서혜부 탈장으로 진단된 5세 남아의 수술 중 출혈이 합병된 전복막지방탈출증을 경험하였기에 보고하는 바이다.