Clinical Study of Inguinal Hernia in Children

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=

Abstract

=

Clinical Study of Inguinal Hernia in Children

Jeong-Meen Seo, M.D. a(ld Poong Man Jung, M.D.

Department of Surgery, College of Medicine, Hanyang University Seoul, Korea

The clinical experience at

~,3A.(J \I\.'lU\I\.a~ h~';'i'~\a ';~j)ai'i~U

by one peulatI1c 'SUIgeon

:m 2,079 children at Hanyang University Hospital from September 1979 to December

1993 was analyzed.

Of 2,046 patients who had primary hernia repairs at Hanyang University Hospital, 1,636 were male and 410 female, and 55.5% of hernias occurred on the right side, 36.0

% on the left, and 8.6% were

bilateral. The patients presented hernia under the age of 12 months were 45.3% and those performed herniotomy under the age of 12 months were 25.5%. Birth weight was less than 2.5kg in III patients(8.7%) of 1,279 data available patients. Ninety( 6.6%) of 1,354 data available patients were premature

«37wks gestation). The proportions of bilateral inguinal hernia and the onset age under 12 months of life in low birth weight babies and premature babies were higher than in full

-

term babies.

Incarcerated inguinal hernia occurred in 327 patients(16.0%) of whom 8 patients were strangulated hernias. The occurrence of incarceration inversely related with age of patients.

The subsequent contralateral inguinal l1ernia following unilateral hernia repairs occurred in 80 patients(4.3%) among which 72 were male and 8 were female. The in- cidence of contralateral inguinal hernia was more frequent in boys( 4.8%) than girls (2.2%) and in cases after left herniotomy(6.4%) than after right

herniotomy(2.9%).

Sixty percent of contralateral inguinal hernia developed within 1 year after primary hernia repair.

The recurrence of inguinal hernia occurred in 6 patients(0.27%) treated at our hos-

pital primarily. There were one or

more

associated congenital anomalies in 83 pa

(2)

tients of which congenital heart diseases were the most common.

Sliding hernia occurred

in

25 patients consisted of 5 boys and 20 girls.

Family history was noted

in

35 patients and there were 28 sets of monozygotic and 3 sets of dizygotic twins.

Index Words: Inguinal hernia; Sliding inguinal hernia; Incarcerated inguinal hernia; Con- tralateral hernia.

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(3)

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Table 1. Sex and Site of Patients with Inguinal Her·

Right I ,eft

- - - -- - - -.

Male 936 568

Bilateral Total (%) 132 1,636 (80.0)

Female 199 168 43 410 (20.0)

Total 1135(55.5) 736(36.0) 175(8.6) 2,046

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Table 2. Operative Age, Sex and Site of Patients with Inguinal Hernia

Male Female

Age Right Left Bilateral Left Bilateral Total (%)

Right

0-lm 12 2 3 0 2 0 19( 0.9)

I-12m 200 156 54 46 37 5 498(24.6 )

1-2yr 207 80 22 20 27 4 360(17.8)

2-4yr 186 113 25 24 37 5 390(19.2)

4-8yr 216 140 20 81 49 19 525(25.9)

28yr 105 71 8 27 15 10 236(11.6)

Total 926 562 132 198 167 43 2,028

Table 3. Onset Age, Sex and Site of Patients with Inguinal Hernia

Male Female

Age Right Left Bilateral Left Bilateral Total (%)

Right

0-lm 61 49 20 13 15 3 161 (11.0)

I-12m 227 141 43 46 41 6 504(34.3)

1-2yr 111 47 9 11 18 5 201(13.7)

2-4yr 120 75 12 33 36 7 283(19.3)

4-8yr 97 76 11 40 22 6 252(17.2)

28yr 22 26 1 11 3 4 67( 4.6)

Total 638 414 96 154 135 31 1,468

(4)

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Male

Age Right Left Bilateral

0-lm 6 1

I-12m 48 19 13

1-2yr 59 12 3

2-4yr 29 11 2

4-8yr 9 5 4

;;::8yr 5 7 0

Total 156 55 23

Table 5. Contents' of Incarcerated Inguinal Hernia.

Content Male Female Total(%)

Omentum 44 6 50**(26.2)

Intestine 41 3 44**(23.0)

lIeo-cecum 25 3 28 (14.7)

Sigmoid colon 2 0 2* ( 1.0)

Ovary & tube 0 66 66 (34.6)

Omental cyst 0 1* ( 0.5)

Total 113 78 191

- - - - -- - - -- - - -- -- -- -

** : omentum+intestine, 3 patients (2 males, 1 female)

* : sigmoid colon+omental cyst, 1 patient(1 male)

Table 6. Sex and Site of Patients with Subsequent Contralateral Hernia

Right to Left Left to Right Total

Male 31 (11) 41( 9) 72(20)

Female 2( 1) 6( 1) 8( 2)

Total 33(12) 47(10) 80(22)

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Right Left Bilateral Total (%)

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8 12 2 96(29.4 )

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0 14( 4.3)

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(5)

Table 7. Age at Primary Hernia Repair of Patients with Subsequent Contralateral Hernia

Male Female

Age Right to Left Left to Right Right to Left Left to Right

0-lm 2 0 0 0

I-12m 10 25 1 1

1-2yr 9 5 0 0

2-4yr 16 8 3

4-8yr 4 11 1 2

:?!8yr 0 0 1

Total 41 50 3 7

Table 8. Interval Between First Repair and Onset of Subsequent Contralateral Hernia

Male Female

Duration

Right to Left Left to Right Right to Left Left to Right

0-lm 11 7 0 1

1-6m 8 14 0 0

6-12m 6 13 0

:?!lyr 6 9 1 2

:?!2yr 4 4 1 1

:?!3yr 3 1 1 2

:?!4yr 3 2 0 0

Total 41 50 3 7

Table 9. Interval to Ipsilateral Recurrence

hterval Male Female

Right Left Right Left

0-6m 4(1) 1 3(2) 0

6-12m 3(1) 1(1) 0 0

:?!lyr 2 0 2(1) 0

unknown 1 0 0 0

Total 10(2) 2(1) 5(3) 0

) : first repair at Hanyang University Hospital

Total( %) 2( 2.0) 37(36.7) 14(13.9) 28(27.7) 18(17.8) 2( 2.0) 101

Total ( %)

19(18.8) 22(21.8) 20(19.8) 18(17.8) 10( 9.9) 7( 6.9) 5( 5.0) 101

Total( %) 8(47.1%) 4(23.5% ) 4(23.5% ) 1(5.9%) l7

Table 10. Operative Age. and Site of Inguinal Hernia of Low Birth Weight( <2.5kg) and Premature( <37wk) Babies

Age Rt

LBW

Lt Bil Total(% ) Premature

Rt Lt Bil Total(% )

0-lm 3 0 0 3( 2.7) 3 0 0 3( 3.3)

I-12m 28 19 10 57(51.4) 16 17 6 39( 43.3)

1-2yr 10 3 2 15(13.5 ) 8 4 2 14(15.6)

2-4yr 8 4 2 14(12.6) 4 8 2 14(15.6)

4-8yr 9 5 3 17(15.3) 6 7 1 14(15.6)

:?!8yr 2 1 2 5( 4.5) 3 1 2 6( 6.7)

Total 60 32 19 111 40 36 13 90

(6)

Table 11. Combined Operations Operation

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Hydrocelectomy Orchiopexy Hypospadia repair Circumcision Total

~ J-H {! ~% A] i>~ ii}~ c}.

No. of patients 2

5

23 152 65 1 188 439

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Table 12. Combined Anomalies

Cardiac

Congenital heart disease PDA

Gastrointestinal

Hirschsprung's disease IHPS

Imperforate anus Biliary atresia Duodenal atresia Duodenal web Genitourinary

Renal agenesis Hypospadia

Pseudoherma phrodi tism Ovotestis

Anorchia

Absence of vas deferens Ectopic adrenal gland Others

Gastroschisis Umbilical hernia Omphalocele

Diaphragmatic hernia Tongue tie

Cleft palate Funnel chest Branchial remnant

Aniridia Laryngomalacia Entropion Strabismus Hemangioma Club foot Polydactyly Total

No. of anomalies

14 5

4 3 1 1

2 1

2

13 4 1 8 4 2 5

2

3

2 88

:AJ'<t% ~{i iiI ~ ~~

7S

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91

~

rJ1

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(7)

Table 13. Twins with Inguinal Hernia Male Pem1:ile Total

0-lm 0

I-12m 8 4

1-2yr 6 1

2-4yr 5 0

4-8yr 5 1

?8yr 3 1

Total 28 7 MZ : monozygotic twin DZ : dizygotic twin

1 12 7 5 6 4 35

tvlZe 1) MZ(lO),DZ(2) MZe 7) tvlZ( 4),DZ(l) MZ( 6) MZ( 4) MZ(32),DZ(3)

.Jl~ .JlAa ~ 65cJ] %0] ~ ~ t:.j-CTable 11).

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7ltg ol ~~~uj ~~Aa {lAJ7l~0] 14cJ]S!..

7}AJ Pl-€:- ti]-F% ;;'tV]

<5Hi

t:.j-(Table 12). ~ {l

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~JA~oH~~Aa %A~O} 28~J, o]i(±Aa ~JA~O} 3

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(8)

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~ 3~Jo] 9) 9i q.

1. Clausen EG, Jake RJ, Binkley FM : Contra·

lateral inguinal exploration of unilateral her·

nia in infants and children. Surgery 44 : 735-740, 1958

2. Rowe MI, Clatworthy HW: Incarcerated and strangulated hernia in children. Arch Surg 101: 136-139,1970

3. McGregor DB, Halverson K, McVay CB : The unilateral pediatric inguinal hernia : Should the contralateral side be explored? J Pediatr Surg 15 : 313-317, 1980

4. Harvey MH, Johnstone MJS, Fossard DP : Inguinal herniotomy in children: a five year

(10)

]servey. Br J Surg 72 : 485-487, 1985 5. "'j ~-£, {j

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