Pediatric Inguinal Hernia Repair

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • All inguinal hernias in children should be repaired after diagnosis.
CONTRAINDICATIONS
  • Weight less than 2 to 3 kg, unless there is a history of incarceration (relative contraindication)
EQUIPMENT
  • Anesthetic equipment
  • Operating table
  • Instrument table
  • Electrocautery device
ANATOMY
  • Boundaries (walls) of the inguinal canal
    • Anterior: External oblique aponeurosis
    • Posterior (floor): Transversalis fascia and transversus abdominis aponeurosis
    • Superior: Internal oblique and transversus abdominis musculoaponeurosis
    • Inferior: Inguinal ligament and lacunar ligament
    • Medial: External (superficial) inguinal ring
    • Lateral: Internal (deep) inguinal ring
  • Components of the spermatic cord
    • Cremasteric muscle fibers
    • Gonadal artery and accompanying veins
    • Genital branch of the genitofemoral nerve
    • Vas deferens
    • Cremasteric vessels (branches of inferior epigastric vessels)
    • Lymphatic vessels and processus vaginalis
  • External (superficial) ring: The ovoid opening of the external oblique aponeurosis is located superior and slightly lateral to the pubic tubercle. The spermatic cord exits the inguinal canal through the external inguinal ring.
  • Internal (deep) ring: The superior crus is the transversus abdominis aponeurotic arch, which is formed by fibers of the lower margin of the transversus abdominis and internal oblique muscles. The inferior crus is the iliopubic tract.
  • Important nerves
    • Iliohypogastric and ilioinguinal
    • Genital branch of the genitofemoral nerve
    • Lateral femoral cutaneous

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Acetaminophen for analgesia
COMPLICATIONS
  • Hydrocele
  • Iatrogenic undescended testis
  • Recurrent hernia
  • Testicular atrophy
  • Injury to the vas deferens
RESULT ANALYSIS
  • After the diagnosis of a reducible hernia is made, repair should be performed soon to avoid incarceration.
  • An incarcerated inguinal hernia must be emergently reduced, either manually or surgically. To minimize the risk for recurrence, definitive hernia repair should be performed within 5 days (within 2 days for infants born prematurely) of the manual reduction.
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