A Study on Infantile Inguinal Hernia Surgery in Recurrent Patients

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  • 小児期鼠径ヘルニア手術における再発症例からの検討
  • ショウニキ ソケイ ヘルニア シュジュツ ニ オケル サイハツ ショウレイ カラ ノ ケントウ

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Purpose: We examined recurrent patients who underwent post-infantile inguinal hernia surgery, reviewed conventional infantile inguinal hernia surgery, and discussed future tasks in new endoscopic surgeries. Methods: Eighteen recurrent patients who underwent previous infantile inguinal hernia surgery in our hospital from July 1998 to December 2011 were examined. The subjects were divided into two groups: eight patients who showed recurrence in childhood, and ten patients who showed recurrence after they grew up. Their disease states were examined by focusing on recurrence mode. Results: Of the eight early-recurrence patients, recurrence was associated with technical error in seven, and associated with damage to the internal inguinal ring in one. Of the ten adult-recurrence patients, recurrence was of the direct type in five, indirect type in four, and femoral hernia in one. In two of the four indirect type subjects, there was no evidence of an opened inguinal canal. In one patient where high ligation was performed without the sac being dissected, an edema was formed within the distal sac. In the other patient, although there was a postoperative trace in the internal inguinal ring, the sac was patent. Conclusions: It has been considered that in infantile inguinal hernia surgery, high ligation is fundamental and strengthening of the posterior wall is not necessary. However, when performing high ligation of the sac, the internal spermatic fascia is also reefed and cut simultaneously, providing an equivalent act to the Marcy's procedure in adult surgery. In patients where the internal inguinal ring is widely dilated and damaged, it is necessary to add reefing to the internal inguinal ring. Not adhering to high ligation and proper attention ensure that the internal inguinal ring is not excessively separated and damaged to effective prevent recurrence. Furthermore, in the endoscopic surgical technique, ligation of the peritonea alone may be necessary to prevent the indirect type occurrence after patients have grown up.

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