IS IT MANDATORY TO LIGATE SAC IN EMERGENCY HERNIOTOMY IN PEDIATRIC AGE GROUP? A PROSPECTIVE COHORT
DOI:
https://doi.org/10.55519/JAMC-03-10312Keywords:
pediatric age group, inguinal hernia, herniotomy, early recurrence, sac ligation, non-ligation of hernia sac, emergency herniotomy, irreducible hernia, obstructed hernia, strangulated hernia.Abstract
Background: Herniotomy is standard treatment for inguinal hernia in children. Paediatric surgeons remain divided on whether ligation of sac is mandatory. In our study, we left the sac open to see early recurrence. Methods: This quasi=experimental study, done in emergency cases, was sequel to our previous study done in elective cases. It was carried out at surgical unit C of Ayub Hospital Complex, Abbottabad, from Jan 2016 to June 2020. Children from birth to 12 years of age were randomly divided into two groups. In group I (experimental), sacs were cut high up and left open during herniotomy while in group II (control), high ligation of hernia sac was done. Follow up was scheduled for day 10 and 1, 3 and 6 months. Patients were assessed for early recurrence and other complications. Results: A total of 151 emergency inguinal herniotomies were done including 147 males (97.4%) and 4 females (2.6%). 136 sacs (90.1%) were ligated with vicryl 3/0 or 4/0 while 15 sacs (9.9%) were left open. We did not find early recurrence, but found 1 case of scrotal hematoma (n=1/15) (6.7%) and 1 case of scrotal oedema (n=1/15) (6.7%) in the experimental group. In control group, complications were similar with 7 cases of hematoma (n=7/136) (5.1%) and 9 cases of scrotal oedema (n=9/136) (6.6%). Conclusion: Complications are comparable in herniotomy with or without ligation of sac but ligation adds an extra step. Herniotomy without sac ligation in children is safe and preferable in emergency setup.
References
Kumar A, Ramakrishnan TS. Single port laparoscopic repair of pediatric inguinal hernias: Our experience at a secondary care center. J Minim Access Surg 2013;9(1):7-12.
Saranga Bharathi R, Arora M, Baskaran V. Pediatric inguinal hernia: laparoscopic versus open surgery. JSLS 2008;12(3):277-81.
Jain VK, Singh S, Garge S, Joshi M, Sanghvi J. Orchidopexy san ligation technique of orchidopexy. Afr J Paediatr Surg 2011;8(1):112-4.
Delikoukos S, Lavant L, Hlias G, Palogos K, Gikas D. The role of hernia sac ligation in postoperative pain in patients with elective tension-free indirect inguinal hernia repair: a prospective randomized study. Hernia 2007;11(5):425-8.
Gharaibeh KI, Matani YY. To ligate or not to ligate the hernial sac in adults? Saudi Med J 2000;21(11):1068-70.
Pant N, Aggarwal SK and Ratan SK. Laparoscopic repair of hernia in children: Comparison between ligation and nonligation of sac. J Indian Assoc Pediatr Surg 2014;19(2):76-9.
Smedberg SG, Broome AE, Gullmo A. Ligation of the hernial sac? Surg Clin North Am 1984;64(2):299-306.
Mohta A, Jain N, Irniraya KP, Saluja SS, Sharma S, Gupta A. Non-ligation of the hernial sac during herniotomy: a prospective study. Pediatr Surg Int 2003;19(6):451-2.
Kumari V, Biswas N, Mitra N, Konar H, Ghosh D, Das SK. Is ligation of hernial sac during orchiopexy mandatory? J Indian Assoc Paediatr Surg 2009;14(2):66-7.
Shulman AG, Amid PK, Lichtenstein IL. Ligation of hernial sac. A needless step in adult hernioplasty. Int Surg 1993;78(2):152-3.
Rafiei MH, Jazini A. Is the ligation of hernial sac necessary in herniotomy for children? A randomized controlled trial of evaluating surgical complications and duration. Adv Biomed Res 2015;4:97.
Sparić R, Lazović B, Mazić S, Delić M, Argirović A. Peritonealization in gynecology and obstetrics--review of literature. Med Pregl 2013;66(7-8):307-10.
Ali K, Kamran H, Khattak IU, Latif H. Non-ligation of indirect hernial sac in children. J Ayub Med Coll Abbottabad 2015;27(1):180-2.
Abbas MH. Outcome of strangulated inguinal hernia. Pak J Med Sci 2005;21(4):445.
Komorowski AL. History of the inguinal hernia repair. In: Inguinal Hernia. IntechOpen; 2014.
Hubbard Jr TB, Khan MZ, Carag Jr VR, Albites VE, Hricko GM. The pathology of peritoneal repair: its relation to the formation of adhesions. Ann Surg 1967;165(6):908-16.
Ceccanti S, Zani A, Mele E, Cozzi DA. Orchidopexy without ligation of the processus vaginalis is not associated with an increased risk of inguinal hernia. Hernia 2014;18(3):339-42.
Kao CY, Li CL, Lin CC, Su CM, Chen CC, Tam KW. Sac ligation in inguinal hernia repair: A meta-analysis of randomized controlled trials. Int J Surg 2015;19:55-60.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
