Обмін досвідом/ Exchange of experience

Inguinal hernia repair by Bianchi incision in boys: a retrospective study/ Лікування пахової грижі у хлопчиків методом Bianchi

Pediatric Surgery International

  • Junshan Lin
  • Dumiao Li
  • Jinwen Chen
  • Li Lin
  • Yali Xu

Original Article – First Online: 29 November 2017

Abstract

Objective

Open inguinal hernia repair by Bianchi incision is a potential alternative technique for the treatment of IH. This study aims to retrospectively analyze boys with IH, who underwent open IH repair by Bianchi incision.

Methods

A total of 3300 boys (1–144 months) with IH from April 2007 to September 2015 were enrolled into this study. An open high scrotal incision (Bianchi incision) to ligate the processus proximal to the internal inguinal ring was performed in patients for IH repair. Then, all patients were followed up after 7 days, 1 month, and 1 year. Operation time, hernia recurrence, hydrocele, testicular atrophy, cosmetic results, and the satisfaction of parents were evaluated.

Results

Among these 3300 boys, 1662 (50.36%) and 1349 (40.88%) boys with IH were operated on the right and left side, respectively, while 289 (8.76%) patients underwent bilateral surgery. The average operation time was 13.0 ± 2.3 min for unilateral cases and 25.2 ± 4.2 min for bilateral cases. Furthermore, among these 3300 boys, 309 boys (9.36%) were lost to follow-up, and the remaining 2991 boys underwent a total of 3245 IH repairs. The complications included 20 recurrences who were repaired with the same technique, one wound rupture, and one acquired undescended testis. No infection, obvious scrotal hematoma, testicular atrophy, and vas deferens injury were found during the follow-up. In most instances, the scars were invisible, obtaining an excellent cosmetic effect.

Conclusion

Inguinal hernia repair by Bianchi incision is a safe, easy and effective technique with cosmetic benefits, which could be a reliable alternative for the treatment of pediatric inguinal hernia.

Keywords

Inguinal hernia repair Bianchi incision Patent processus vaginalis (PPV) 

Abbreviations

IH Inguinal hernia
PPV Patent processus vaginalis
CPPV Contralateral patent processus vaginalis
MCH Metachronous contralateral hernia
LPEC Laparoscopic percutaneous extraperitoneal closure

References

  1. Lau ST, Lee YH, Caty MG (2007) Current management of hernias and hydroceles. Semin Pediatr Surg 16(1):50–57. https://doi.org/10.1053/j.sempedsurg.2006.10.007CrossRefPubMedGoogle Scholar
  2. Schwobel MG, Schramm H, Gitzelmann CA (1999) The infantile inguinal hernia—a bilateral disease? Pediatr Surg Int 15(2):115–118. https://doi.org/10.1007/s003830050529CrossRefPubMedGoogle Scholar
  3. Parelkar SV, Oak S, Gupta R, Sanghvi B, Shimoga PH, Kaltari D, Prakash A, Shekhar R, Gupta A, Bachani M (2010) Laparoscopic inguinal hernia repair in the pediatric age group—experience with 437 children. J Pediatr Surg 45(4):789–792. https://doi.org/10.1016/j.jpedsurg.2009.08.007CrossRefPubMedGoogle Scholar
  4. Ahmed H, Youssef MK, Salem EA, Fawzi AM, Desoky EA, Eliwa AM, Sakr AM, Shahin AM (2016) Efficacy of laparoscopically assisted high ligation of patent processus vaginalis in children. J Pediatr Urol 12(1):50 e51–50 e55. https://doi.org/10.1016/j.jpurol.2015.05.036CrossRefGoogle Scholar
  5. Schier F (2000) Laparoscopic surgery of inguinal hernias in children—initial experience. J Pediatr Surg 35(9):1331–1335. https://doi.org/10.1053/jpsu.2000.9326CrossRefPubMedGoogle Scholar
  6. Lazar DA, Lee TC, Almulhim SI, Pinsky JR, Fitch M, Brandt ML (2011) Transinguinal laparoscopic exploration for identification of contralateral inguinal hernias in pediatric patients. J Pediatr Surg 46(12):2349–2352. https://doi.org/10.1016/j.jpedsurg.2011.09.027CrossRefPubMedGoogle Scholar
  7. Mollen KP, Kane TD (2007) Inguinal hernia: what we have learned from laparoscopic evaluation of the contralateral side. Curr Opin Pediatr 19(3):344–348. https://doi.org/10.1097/MOP.0b013e3281574597CrossRefPubMedGoogle Scholar
  8. Alzahem A (2011) Laparoscopic versus open inguinal herniotomy in infants and children: a meta-analysis. Pediatr Surg Int 27(6):605–612. https://doi.org/10.1007/s00383-010-2840-xCrossRefPubMedGoogle Scholar
  9. Kim S, Hui T (2013) Laparoscopically assisted repair of inguinal hernia through a micro-incision and extra-peritoneal division and ligation of the hernia sac. Pediatr Surg Int 29(4):331–334. https://doi.org/10.1007/s00383-012-3241-0CrossRefPubMedGoogle Scholar
  10. Yang C, Zhang H, Pu J, Mei H, Zheng L, Tong Q (2011) Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis. J Pediatr Surg 46(9):1824–1834. https://doi.org/10.1016/j.jpedsurg.2011.04.001CrossRefPubMedGoogle Scholar
  11. Arena S, Impellizzeri P, Perrone P, Scalfari G, Centorrino A, Turiaco N, Russo T, Antonuccio P, Romeo C (2016) Our experience in transcrotal orchidopexy in children affected by palpable undescended testis. Eur J Pediatr Surg (Zeitschrift fur Kinderchirurgie) 26(1):13–16. https://doi.org/10.1055/s-0035-1563674Google Scholar
  12. Koyle MA, Walsh R, Caruso A, Wilson E (1999) Scrotal (Bianchi) approach to patent processus vaginalis in children. Tech Urol 5(2):95–99PubMedGoogle Scholar
  13. Fearne C, Abela M, Aquilina D (2002) Scrotal approach for inguinal hernia and hydrocele repair in boys. Eur J Pediatr Surg (Zeitschrift fur Kinderchirurgie). 12 (2):116–117. https://doi.org/10.1055/s-2002-30160CrossRefGoogle Scholar
  14. Gokcora IH, Yagmurlu A (2003) A longitudinal follow-up using the high trans-scrotal approach for inguinal and scrotal abnormalities in boys. Hernia J Hernias Abdom Wall Surg 7(4):181–184. https://doi.org/10.1007/s10029-003-0136-yGoogle Scholar
  15. Shih TY, Uen YH (2012) Single scrotal incision for repair of bilateral inguinal hernias in boys. Pediatr Surg Int 28(4):417–420. https://doi.org/10.1007/s00383-011-3049-3CrossRefPubMedGoogle Scholar
  16. Helal AA (2015) Laparoscopic single instrument closure of inguinal hernia in female children: a novel technique. J Pediatr Surg 50(9):1613–1616. https://doi.org/10.1016/j.jpedsurg.2015.05.003CrossRefPubMedGoogle Scholar
  17. Miyake H, Fukumoto K, Yamoto M, Nouso H, Kaneshiro M, Nakajima H, Koyama M, Urushihara N (2016) Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases. Surg Endosc 30(4):1466–1472. https://doi.org/10.1007/s00464-015-4354-zCrossRefPubMedGoogle Scholar
  18. Endo M, Watanabe T, Nakano M, Yoshida F, Ukiyama E (2009) Laparoscopic completely extraperitoneal repair of inguinal hernia in children: a single-institute experience with 1,257 repairs compared with cut-down herniorrhaphy. Surg Endosc 23(8):1706–1712. https://doi.org/10.1007/s00464-008-0300-7CrossRefPubMedPubMedCentralGoogle Scholar
  19. Montupet P, Esposito C (2011) Fifteen years experience in laparoscopic inguinal hernia repair in pediatric patients. Results and considerations on a debated procedure. Surg Endosc 25(2):450–453. https://doi.org/10.1007/s00464-010-1188-6CrossRefPubMedGoogle Scholar
  20. Toki A, Watanabe Y, Sasaki K, Tani M, Ogura K, Wang ZQ (2003) Adopt a wait-and-see attitude for patent processus vaginalis in neonates. J Pediatr Surg 38(9):1371–1373CrossRefPubMedGoogle Scholar
  21. Saad S, Mansson J, Saad A, Goldfarb MA (2011) Ten-year review of groin laparoscopy in 1001 pediatric patients with clinical unilateral inguinal hernia: an improved technique with transhernia multiple-channel scope. J Pediatr Surg 46(5):1011–1014. https://doi.org/10.1016/j.jpedsurg.2010.12.020CrossRefPubMedGoogle Scholar
  22. Eller Miranda M, Duarte Lanna JC (2002) Videolaparoscopy of the contralateral internal inguinal ring via the hernia sac in children with unilateral inguinal hernia-initial experience in Brazil, with a meta-analysis. Pediatr Surg Int 18(5–6):463–469. https://doi.org/10.1007/s00383-002-0792-5CrossRefPubMedGoogle Scholar
  23. Kalantari M, Shirgir S, Ahmadi J, Zanjani A, Soltani AE (2009) Inguinal hernia and occurrence on the other side: a prospective analysis in Iran. Hernia J Hernias Abdom Wall Surg 13(1):41–43. https://doi.org/10.1007/s10029-008-0411-zCrossRefGoogle Scholar
  24. Steven M, Greene O, Nelson A, Brindley N (2010) Contralateral inguinal exploration in premature neonates: is it necessary? Pediatr Surg Int 26(7):703–706. https://doi.org/10.1007/s00383-010-2614-5CrossRefPubMedGoogle Scholar
  25. Maillet OP, Garnier S, Dadure C, Bringuier S, Podevin G, Arnaud A, Linard C, Fourcade L, Ponet M, Bonnard A, Breaud J, Lopez M, Piolat C, Sapin E, Harper L, Kalfa N (2014) Inguinal hernia in premature boys: should we systematically explore the contralateral side? J Pediatr Surg 49(9):1419–1423. https://doi.org/10.1016/j.jpedsurg.2014.01.055CrossRefPubMedGoogle Scholar
  26. Centeno-Wolf N, Mircea L, Sanchez O, Genin B, Lironi A, Chardot C, Birraux J, Wildhaber BE (2015) Long-term outcome of children with patent processus vaginalis incidentally diagnosed by laparoscopy. J Pediatr Surg 50(11):1898–1902. https://doi.org/10.1016/j.jpedsurg.2015.07.001CrossRefPubMedGoogle Scholar
  27. Kokorowski PJ, Wang HH, Routh JC, Hubert KC, Nelson CP (2014) Evaluation of the contralateral inguinal ring in clinically unilateral inguinal hernia: a systematic review and meta-analysis. Hernia J Hernias Abdom Wall Surg 18(3):311–324. https://doi.org/10.1007/s10029-013-1146-zCrossRefGoogle Scholar
  28. Lee DY, Baik YH, Kwak BS, Oh MG, Choi WY (2015) A purse-string suture at the level of internal inguinal ring, taking only the peritoneum leaving the distal sac: is it enough for inguinal hernia in pediatric patients? Hernia J Hernias Abdom Wall Surg. 19 (4):607–610. https://doi.org/10.1007/s10029-015-1348-7CrossRefGoogle Scholar
  29. Shalaby R, Ismail M, Gouda S, Yehya AA, Gamaan I, Ibrahim R, Hassan S, Alazab A (2015) Laparoscopic management of recurrent inguinal hernia in childhood. J Pediatr Surg 50(11):1903–1908. https://doi.org/10.1016/j.jpedsurg.2015.07.015CrossRefPubMedGoogle Scholar
  30. Koivusalo AI, Korpela R, Wirtavuori K, Piiparinen S, Rintala RJ, Pakarinen MP (2009) A single-blinded, randomized comparison of laparoscopic versus open hernia repair in children. Pediatrics 123(1):332–337. https://doi.org/10.1542/peds.2007-3752CrossRefPubMedGoogle Scholar
  31. Mouravas V, Sfoungaris DK (2015) Shouldn’t the laparoscopic operation for inguinal hernia repair in children be some steps closer to the open procedure? J Pediatr Urol 11(6):373–374. https://doi.org/10.1016/j.jpurol.2015.09.004CrossRefPubMedGoogle Scholar
  32. Mouravas V, Sfoungaris D (2016) What is the impact of simple ligation on patent processus vaginalis? J Pediatr Urol 12(5):323. https://doi.org/10.1016/j.jpurol.2016.04.025CrossRefPubMedGoogle Scholar
  33. Wang KS (2012) Assessment and management of inguinal hernia in infants. Pediatrics 130(4):768–773. https://doi.org/10.1542/peds.2012-2008CrossRefPubMedGoogle Scholar
  34. Saka R, Okuyama H, Sasaki T, Nose S, Yoneyama C (2014) Safety and efficacy of laparoscopic percutaneous extraperitoneal closure for inguinal hernias and hydroceles in children: a comparison with traditional open repair. J Laparoendosc Adv Surg Tech Part A 24(1):55–58. https://doi.org/10.1089/lap.2013.0109CrossRefGoogle Scholar
  35. Chen K, Xiang G, Wang H, Xiao F (2011) Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients. J Laparoendosc Adv Surg Tech Part A 21(5):445–448. https://doi.org/10.1089/lap.2009.0294CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017
відdr.shevchuk