NON-LIGATION OF INDIRECT HERNIAL SAC IN CHILDREN
AbstractBackground: It is still a matter of debate whether to ligate the indirect hernial sac during herniotomy or leave it open. We designed this study to find out the complications associated with leaving the sac open. Methods: This observational study was carried out at Surgical Unit C, Ayub Medical College, Abbottabad from January 2007 to December 2012. The hernial sacs of some children, aged 5 months to 12 years, undergoing herniotomies were left open, and these children were closely followed for development of complications especially early recurrence, due to this non-ligation of hernial sac. Results: A total of 23 male children who underwent herniotomies for indirect inguinal hernia and undescended testes were included in the study. No early or late hernia recurrence was observed in these children although minor complications like wound infection and seroma were noted in 2 children. Conclusion: Excision of the hernia sac and leaving the stump open is safe and effective with no early recurrence.Keywords: Non ligation, Hernial sac, Herniotomy
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;19:451–2.
Gharaibeh KI, Matani YY. To ligate or not to ligate the hernial sac in adults? Saudi Med J 2000;21:1068–70.
Huang CJ, Sun HP. Non ligation of indirect hernia sac in senior male patients with dilated internal ring. Formosan J Surg 2013; 46:76–8.
McClusky DA 3rd, Mirilas P, Zoras O, Skandalakis PN, Skandalakis JE. Groin hernia: anatomical and surgical history. Arch Surg 2006; 141:1035–42.
Postlethwait RW. Recurrent inguinal hernia. Ann Surg 1985; 202:777–9.
Ferguson DJ. Closure of the hernia sac- pro and con. In: Nyphus LM, ed. Hernia. 2nd ed. Philadelphia: Lippincott; 1978:152–53.
Smedberg SGG, Broomé AEA, Gullmo A. Ligation of the hernial sac? Surg Clin North Am 1984;64:299–306.
Shulman AG, Amid PK, Lichtenstein IL. Ligation of the hernial sac. A needless step in adult hernioplasty. Int Surg 1993;78:152–3.
Abrahamson J Hernias. In: Zinner MJ, Schwartz SI, EllisH (eds) Maingot’s abdominal surgery (10th edn). Prentice Hall, London,1997. pp 479–580.
Kumari V, Biswas N, Mitra N, Konar H, Ghosh D, Das SK. Is ligation of hernia sac during orchidopexy mandatory? J Indian Assoc Pediatr Surg 2009;14:66–7.
Riquelme M, Aranda A, Riquelme QM. Laparoscopic pediatric inguinal hernia repair: No ligation, just resection. J Laparoendosc Adv Surg Tech A 2010;20:77–80.
Hubbard TB, Khan MZ, Carag VR Jr, Albites VE, Hricko GM. The pathology of peritoneal repair: its relation to the formation of adhesions. Ann Surg 1967; 165:908–16.
Ellis H, Heddle R. Does the peritoneum need to be closed at laparotomy? Br J Surg 1977;64: 733–6.
Bisgaard, T, Kehlet H, Bay-Nielsen M B, Iversen MB, Wara P, et al. ‘Nationwide study of early outcomes after incisional hernia repair.’ Br J Surg 2009;96:1452–7.