Deep Inguinal Ring in Herniorrhaphy of Pediatric Patients

Abstract

Herniorrhaphy is one of the most common operations in pediatric surgery. Methods of herniorrhaphy are high ligation with or without reinforcement, the procedure being selected based on personal preferences. There have been no definite criteria set for when to use the reinforcement procedure. Aims of this study were ① to compare the diameter of deep inguinal ring(DIR) of different groups, ② to find out the surgical indications of reinforcement procedures in herniorrhaphy of pediatric patients. The author measured the diameter of DIR using a Hegar dilator which was introduced into DIR after opening the hernia sac. Minimum diameter was defined as the diameter which could not be felt any resistance when entering the DIR, and maximum diameter as the largest introducible diameter with gentle force. The diameters of each group were compared to other groups with: ① hydrocele vs inguinal hernia, ② hydrocele vs inguinal hernia, ③ male vs female in ingu inal hernia and ④ different age in inguinal hernia. The differences between the minimal diameters among groups ①, ② and ④ were significant(p<0.05), but not in ③. There were no significant differences in maximum diameters among any of the groups. In conclusion, the diameter of DIR was different between inguinal hernia groups and hydrocele groups. Wide range(2~10mm) of the diameter of DIR was observed in patients with inguinal hernia. Also Hegar dilator was considered useful tool when the diameter of DIR was to be measured for selecting reinforcement procedure in hernia repair.