Advertisement

Inguinal Hernia and Hydrocele

  • Ciro EspositoEmail author
  • Maria Escolino
  • Alessandro Settimi
  • Giuseppe Cortese
Chapter

Abstract

The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. In particular, inguinal hernia is a commonly encountered condition in neonates and premature infants. Open herniotomy has always been the standard procedure for this group of patients over the years. With the advent of minimally invasive surgery (MIS), laparoscopic repair has been introduced as a viable alternative to open inguinal repair; however, its use in neonates and premature babies is still limited.

The authors describe the principles of diagnostic assessment, timing for surgery, anesthetic management, and specific anesthetic risks of neonates and premature infants undergoing inguinal hernia repair underlying the differences between inguinal approach and minimally invasive surgery (MIS).

The authors also report a comparative outcome analysis between open and laparoscopic inguinal hernia repair in neonates and premature infants, by evaluating the following parameters: hernia recurrence, postoperative complications (testicular atrophy, wound infection, iatrogenic cryptorchidism), contralateral patency of peritoneal vaginal duct, and metachronous hernia.

Other discussed points are the current management of incarcerated hernias, recurrent hernias, and other rare hernias in this patient population.

Finally, the authors discuss the role of laparoscopy in the surgical treatment of inguinal hernia and hydrocele underlying that the current use of MIS has completely changed the management of inguinal hernia also in neonates and premature infants.

Keywords

Inguinal hernia Laparoscopy Infants Premature Recurrence Incarceration Hydrocele 

References

  1. 1.
    Cox JA. Inguinal hernia of childhood. Surg Clin North Am. 1985;65(5):1331–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Harper RG, Garcia A, Sia C. Inguinal hernia: a common problem of premature infants weighing 1,000 grams or less at birth. Pediatrics. 1975;56(1):112–5.PubMedGoogle Scholar
  3. 3.
    Pini Prato A, Rossi V, Mosconi M, Disma N, Mameli L, Montobbio G, Michelazzi A, Faranda F, Avanzini S, Buffa P, Ramenghi L, Tuo P, Mattioli G. Inguinal hernia in neonates and ex-preterm: complications, timing and need for routine contralateral exploration. Pediatr Surg Int. 2015;31:131–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Parelkar SV, Oak S, Gupta R, Sanghvi B, Shimoga PH, Kaltari D, Prakash A, Shekhar R, Gupta A, Bachani M. Laparoscopic inguinal hernia repair in the pediatric age group—experience with 437 children. J Pediatr Surg. 2010;45(4):789–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Holcomb GW 3rd, Brock JW 3rd, Morgan WM 3rd. Laparoscopic evaluation for a contralateral patent processus vaginalis. J Pediatr Surg. 1994;29(8):970–3. discussion 974PubMedCrossRefGoogle Scholar
  6. 6.
    Esposito C, Escolino M, Settimi A. Laparoscopic pediatric inguinal hernia repair using purse-string suture: technical recommendations after 20 years experience. J Laparoendosc Adv Surg Tech A. 2016a;26(9):748–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Esposito C, Escolino M, Turrà F, Roberti A, Cerulo M, Farina A, Caiazzo S, Cortese G, Servillo G, Settimi A. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg. 2016b;25(4):232–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Misra D, Hewitt G, Potts SR, Brown S, Boston VE. Inguinal herniotomy in young infants, with emphasis on premature neonates. J Pediatr Surg. 1994;29(11):1496–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Esposito C, Montinaro L, Alicchio F, Scermino S, Basile A, Armenise T, Settimi A. Technical standardization of laparoscopic herniorrhaphy in pediatric patients. World J Surg. 2009;33(9):1846–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Schier F. Laparoscopic inguinal hernia repair: a prospective personal series of 542 children. J Pediatr Surg. 2006;41(6):1081–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Nagraj S, Sinha S, Grant H. The incidence of complications following primary inguinal herniotomy in babies weighing 5 Kg or less. Pediatr Surg Int. 2006;22:500–2.PubMedCrossRefGoogle Scholar
  12. 12.
    Fette AM, Hollwarth ME. Special aspects of neonatal inguinal hernia and herniotomy. Hernia. 2001;5(2):92–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Krieger NR, Schocat SJ, McGowan V. Early hernia repair in the premature infant: long-term follow-up. J Pediatr Surg. 1994;29:978–82.PubMedCrossRefGoogle Scholar
  14. 14.
    Phelps S, Agrawal M. Morbidity after neonatal inguinal herniotomy. J Pediatr Surg. 1997;32:445–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Chan IHY, Lau CT, Chung PHY, Chan KL, Lan LCL, Wong KKY, Tam PKH. Laparoscopic inguinal hernia repair in premature neonates: is it safe? Pediatr Surg Int. 2013;29:327–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Esposito C, Alicchio F, Giurin I, Castellano M, Settimi A. Technical standardization of laparoscopic direct hernia repair in pediatric patients. J Laparoendosc Adv Surg Tech A. 2012a;22(1):113–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Esposito C, Montinaro L, Alicchio F, Savanelli A, Armenise T, Settimi A. Laparoscopic treatment of inguinal hernia in the first year of life. J Laparoendosc Adv Surg Tech A. 2010;20(5):473–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Esposito C, Turial S, Escolino M, Giurin I, Alicchio F, Enders J, Krause K, Settimi A, Schier F. Laparoscopic inguinal hernia repair in premature babies weighing 3 kg or less. Pediatr Surg Int. 2012b;28:989–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Turial S, Enders J, Krause K, Schier F. Laparoscopic inguinal herniorrhaphy in premature infants. Eur J Pediatr Surg. 2010;20:371–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Turial S, Enders J, Krause K, Schier F. Laparoscopic inguinal herniorrhaphy in babies weighing 5 kg or less. Surg Endosc. 2011;25:72–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Pastore V, Bartoli F. Neonatal laparoscopic inguinal hernia repair: a 3-year experience. Hernia. 2015;19:611–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Shalaby R, Ibrahem R, Shahin M, Yehya A, Abdalrazek M, Alsayaad I, Shouker MA. Laparoscopic hernia repair versus open herniotomy in children: a controlled randomized study. Minim Invasive Surg. 2012;2012:484135.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Perlstein J, Du Bois JJ. The role of laparoscopy in the management of suspected recurrent paediatric hernias. J Pediatr Surg. 2000;35:1205–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Schier F, Montoupet P, Esposito C. Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs. J Pediatr Surg. 2002;37:323–7.Google Scholar
  25. 25.
    Ron O, Eaton S, Pierro A. Systematic review of the risk of developing a metachronous contralateral inguinal hernia in children. Br J Surg. 2007;94:804–11.PubMedCrossRefGoogle Scholar
  26. 26.
    Esposito C, Escolino M, Farina A, Settimi A. Two decade of history of laparoscopic pediatric inguinal hernia repair. J Laparoendosc Adv Surg Tech A. 2014a;24(9):669–70.PubMedCrossRefGoogle Scholar
  27. 27.
    Esposito C, St Peter SD, Escolino M, Juang D, Settimi A, Holcomb GW 3rd. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review. J Laparoendosc Adv Surg Tech A. 2014b;24(11):811–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Esposito C, Escolino M, Farina A, Cerulo M, Cortese G, Caprio MG, De Pascale T, Settimi A. The role of bowel preparation to optimize working space in laparoscopic inguinal hernia repair in infants. J Pediatr Surg. 2014c;49(10):1536–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Lau S, Lee Y, Caty M. Current management of hernias and hydroceles. Sem Pediatr Surg. 2007;16(1):50–7.CrossRefGoogle Scholar
  30. 30.
    Brisson P, Patel H, Feins NJ. Cremasteric muscle hypertrophy accompanies inguinal hernias in children. J Pediatr Surg. 1999;34(9):1320–1.PubMedCrossRefGoogle Scholar
  31. 31.
    Coren ME, Madden NP, Haddad M, Lissauer TJ. Incarcerated inguinal hernia in premature babies—a report of two cases. Acta Paediatr. 2001;90(4):453–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Boley SJ, Cahn D, Lauer T, Weinberg G, Kleinhaus S. The irreducible ovary: a true emergency. J Pediatr Surg. 1991;26(9):1035–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Madden N. Testis, hydrocele, and varicocele. Essent Paediatr Urol. 2007;1691:130.Google Scholar
  34. 34.
    Wiener ES, Touloukian RJ, Rodgers BM, Grosfeld JL, Smith EI, Ziegler MM, Coran AG. Hernia survey of the section on surgery of the American Academy of Pediatrics. J Pediatr Surg. 1996;31(8):1166–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Patel A, Clark SR, Schiffmiller M, Schoenberg C, Tewfik G. A survey of practice patterns in the use of laryngeal mask by pediatric anesthesiologists. Paediatr Anaesth. 2015;25(11):1127–31.PubMedCrossRefGoogle Scholar
  36. 36.
    Frumiento C, Abajian JC, Vane DW. Spinal anesthesia for preterm infants undergoing inguinal hernia repair. Arch Surg. 2000;135(4):445–51.PubMedCrossRefGoogle Scholar
  37. 37.
    Jones LJ, Craven PD, Lakkundi A, Foster JP, Badawi N. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev. 2015;9(6):CD003669.Google Scholar
  38. 38.
    Broadman LM. Use of spinal or continuous caudal anesthesia for inguinal hernia repair in premature infants: are there advantages? Reg Anesth. 1996;21(6 suppl):108–13.PubMedGoogle Scholar
  39. 39.
    Morrison K, Herbst K, Corbett S, Herndon CD. Pain management practice patterns for common pediatric urology procedures. Urology. 2014;83(1):206–10.PubMedCrossRefGoogle Scholar
  40. 40.
    Jing Wang G, Belley-Cotè E, Burry L, Duffett M, Karachi T, Perri D, Alhazzani W, D’Aragon F, Wunsch H, Rochwerg B. Clonidine for sedation in the critically ill: a systematic review and meta-analysis (protocol). Syst Rev. 2015;4:154.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Steward DJ. Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiology. 1982;56(4):304–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Allen GS, Cox CS Jr, White N, Khalil S, Rabb M, Lally KP. Postoperative respiratory complications in ex-premature infants after inguinal herniorrhaphy. J Pediatr Surg. 1998;33(7):1095–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Warner LO, Teitelbaum DH, Caniano DA, Vanik PE, Martino JD, Servick JD. Inguinal herniorrhaphy in young infants: perianesthetic complications and associated preanesthetic risk factors. J Clin Anesth. 1992;4(6):455–61.PubMedCrossRefGoogle Scholar
  44. 44.
    Bell C, Dubose R, Seashore J, Touloukian R, Rosen C, Oh TH, Hughes CW, Mooney S, O'Connor TZ. Infant apnea detection after herniorrhaphy. J Clin Anesth. 1995;7(3):219–23.PubMedCrossRefGoogle Scholar
  45. 45.
    Malviya S, Swartz J, Lerman J. Are all preterm infants younger than 60 weeks postconceptual age at risk for postanesthetic apnea? Anesthesiology. 1993;78(6):1076–81.PubMedCrossRefGoogle Scholar
  46. 46.
    Kim GS, Song JG, Gwak MS, Yang M. Postoperative outcome in formerly premature infants undergoing herniorrhaphy: comparison of spinal and general anesthesia. J Korean Med Sci. 2003;18(5):691–5.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Groff DB, Nagaraj HS, Pietsch JB. Inguinal hernias in premature infants operated on before discharge from the neonatal intensive care unit. Arch Surg. 1985;120(8):962–3.PubMedCrossRefGoogle Scholar
  48. 48.
    Misra D. Inguinal hernias in premature babies: wait or operate? Acta Paediatr. 2001;90(4):370–1.PubMedCrossRefGoogle Scholar
  49. 49.
    Rescorla FJ, Grosfeld JL. Inguinal hernia repair in the perinatal period and early infancy: clinical considerations. J Pediatr Surg. 1984;19(6):832–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Uemura S, Woodward AA, Amerena R, Drew J. Early repair of inguinal hernia in premature babies. Pediatr Surg Int. 1999;15(1):36–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Vaos G, Gardikis S, Kambouri K, Sigalas I, Kourakis G, Petoussis G. Optimal timing for repair of an inguinal hernia in premature infants. Pediatr Surg Int. 2010;26(4):379–85.PubMedCrossRefGoogle Scholar
  52. 52.
    Lautz TB, Raval MV, Reynolds M. Does timing matter? A national perspective on the risk of incarceration in premature neonates with inguinal hernia. J Pediatr. 2011;158(4):573–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Niyogi A, Tahim AS, Sherwood WJ, De Caluwe D, Madden NP, Abel RM, Haddad MJ, Clarke SA. A comparative study examining open inguinal herniotomy with and without hernioscopy to laparoscopic inguinal hernia repair in a pediatric population. Pediatr Surg Int. 2010;26(4):387–92.PubMedCrossRefGoogle Scholar
  54. 54.
    Schier F. Laparoscopic herniorrhaphy in girls. J Pediatr Surg. 1998;33(10):1495–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Esposito C, Escolino M, Cortese G, Aprea G, Turrà F, Farina A, Roberti A, Cerulo M, Settimi A. Twenty-year experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs. Surg Endosc. 2017;31(3):1461–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Ostlie DJ, Ponsky TA. Technical options of the laparoscopic pediatric inguinal hernia repair. J Laparoendosc Adv Surg Tech A. 2014;24(3):194–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Becmeur F, Philippe P, Lemandat-Schultz A, Moog R, Grandadam S, Lieber A, Toledano D. A continuous series of 96 laparoscopic inguinal hernia repairs in children by a new technique. Surg Endosc. 2004;18(12):1738–41.PubMedCrossRefGoogle Scholar
  58. 58.
    Takehara H, Yakabe S, Kameoka K. Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions. J Pediatr Surg. 2006;41(12):1999–2003.PubMedCrossRefGoogle Scholar
  59. 59.
    Montupet P, Esposito C. Laparoscopic treatment of congenital inguinal hernia in children. J Pediatr Surg. 1999;34(3):420–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Alzahem A. Laparoscopic versus open inguinal herniotomy in infants and children: a meta-analysis. Pediatr Surg Int. 2011;27(6):605–12.PubMedCrossRefGoogle Scholar
  61. 61.
    Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W. Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A. 2006;16:513–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Grosfeld JL. Current concepts in inguinal hernia in infants and children. World J Surg. 1989;13(5):506–15.PubMedCrossRefGoogle Scholar
  63. 63.
    Stylianos S, Jacir NN, Harris BH. Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg. 1993;28(4):582–3.PubMedCrossRefGoogle Scholar
  64. 64.
    Esposito C, Turial S, Alicchio F, Enders J, Castagnetti M, Krause K, Settimi A, Schier F. Laparoscopic repair of incarcerated inguinal hernia. A safe and effective procedure to adopt in children. Hernia. 2013;17(2):235–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Miyano G, Yamataka A, Okada Y, Shimotakahara A, Kaneko K, Lane GJ, Yamashiro Y, Miyano T. Sigmoidocolocystoplasty for augmentation of iatrogenic small capacity bladder caused by direct injury to the bladder during inguinal hernia repair: long term follow-up. Pediatr Surg Int. 2004;20:61–4.PubMedCrossRefGoogle Scholar
  66. 66.
    Choi W, Hall NJ, Garriboli M, Ron O, Curry JI, Cross K, Drake DP, Kiely EM, Eaton S, De Coppi P, Pierro A. Outcomes following laparoscopic inguinal hernia repair in infants compared with older children. Pediatr Surg Int. 2012;28:1165–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Hughes K, Horwood JF, Clements C, Leyland D, Corbett HJ. Complications of inguinal herniotomy are comparable in term and premature infants. Hernia. 2016;20:565–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Marinković S, Bukarica S, Cvejanov M, Peković-Zrnić V, Jokić R, Dobanovacki D. Inguinal herniotomy in prematurely born infants. Med Pregl. 1998;51(5–6):228–30.PubMedGoogle Scholar
  69. 69.
    Saha N, Biswas I, Rahman MA, Islam MK. Surgical outcome of laparoscopic and open surgery of pediatric inguinal hernia. Mymensingh Med J. 2013;22(2):232–6.PubMedGoogle Scholar
  70. 70.
    Lin CD, Tsai YC, Chang SJ, Yang SS. Surgical outcomes of mini laparoscopic herniorrhaphy in infants. J Urol. 2011;185(3):1071–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Raveenthiran V. Controversies regarding neonatal inguinal hernia. J Neonatal Surg. 2014;3(3):31–4.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Burgmeier C, Dreyhaupt J, Schier F. Gender-related differences of inguinal hernia and asymptomatic patent processus vaginalis in term and preterm infants. J Pediatr Surg. 2015;50:478–80.PubMedCrossRefGoogle Scholar
  73. 73.
    Lima M, Ruggeri G, Domini M, et al. Laparoscopic treatment of bilateral direct inguinal hernia by using the vesical ligament as an autologous patch. Pediatr Endosurg Innov Technol. 2002;6:277–9.CrossRefGoogle Scholar
  74. 74.
    Esposito C, Montupet P. Laparoscopic treatment of recurrent inguinal hernia in children. Pediatr Surg Int. 1998;14(3):182–4.PubMedCrossRefGoogle Scholar
  75. 75.
    Kaya M, Huckstedt T, Schier F. Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg. 2006;41(3):567–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Yang C, Zhang H, Pu J, Mei H. Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis. J Pediatr Surg. 2011;46:1824–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ciro Esposito
    • 1
    Email author
  • Maria Escolino
    • 1
  • Alessandro Settimi
    • 1
  • Giuseppe Cortese
    • 2
  1. 1.Department of Translational Medical Sciences, Pediatric Surgery UnitFederico II UniversityNaplesItaly
  2. 2.Department of Anesthesiology, Pediatric Anesthesiology UnitFederico II UniversityNaplesItaly

Personalised recommendations