The downregulation of genes encoding muscle proteins have a potential role in the development of scrotal hernia in pigs.

BACKGROUND: Testicular descent is a physiological process regulated by many factors. Eventually, disturbances in the embryological/fetal development path facilitate the occurrence of scrotal hernia, a congenital malformation characterized by the presence of intestinal portions within the scrotal sac due to the abnormal expansion of the inguinal ring. In pigs, some genes have been related to this anomaly, but the genetic mechanisms involved remain unclear. This study aimed to investigate the expression profile of a set of genes potentially involved with the manifestation of scrotal hernia in the inguinal ring tissue. METHODS AND RESULTS: Tissue samples from the inguinal ring/canal of normal and scrotal hernia-affected male pigs with approximately 30 days of age were used. Relative expression analysis was performed using qPCR to confirm the expression profile of 17 candidate genes previously identified in an RNA-Seq study. Among them, the Myosin heavy chain 1 (MYH1), Desmin (DES), and Troponin 1 (TNNI1) genes were differentially expressed between groups and had reduced levels of expression in the affected animals. These genes encode proteins involved in the formation of muscle tissue, which seems to be important for increasing the resistance of the inguinal ring to the abdominal pressure, which is essential to avoid the occurrence of scrotal hernia. CONCLUSIONS: The downregulation of muscular candidate genes in the inguinal tissue clarifies the genetic mechanisms involved with this anomaly in its primary site, providing useful information for developing strategies to control this malformation in pigs and other mammals.

Laparoscopic management of infantile hydrocele in pediatric age group.

PURPOSE: To evaluate laparoscopic management of hydroceles in pediatrics, with evaluation of the internal inguinal ring (IIR) and the PPV (patent processus vaginalis) in different types of hydroceles, and the incidence of the contralateral PPV. METHODS: The IIR and the type of hydrocele on the same side of 93 patients with 106 infantile hydroceles were evaluated and managed, in addition to contralateral side. RESULTS: The IIR on same side was closed in 8.5% (Type I) and patent in 91.5% (Type II and III) with different shapes. Contralateral IIR was open in 88.7% of cases. The operative time was 30.99 ± 7.23 min, with no intra-operative complication. The vas deferens and testicular vessels were secured and there were no injuries or bleeding. The conversion rate was zero, and all procedures (Type II and II) were completed totally laparoscopic. No post-operative complications except a case of tense hydrocele developed scrotal edema that managed conservatively. CONCLUSION: Laparoscopic hydrocelectomy is safe, applicable and feasible for management of different types of hydroceles in pediatrics. The IIR is patent in nearly all cases with/out communication to the hydrocele. The contralateral IIR can be managed in the same session. Laparoscopic hydrocelectomy with/out hydrocelectomy and IIR closure is essential in preventing recurrence.

Age-related changes in inguinal region anatomy from 0 to 19 years of age.

Knowledge of the age-related changes in inguinal region anatomy is essential in pediatric urological and abdominal surgery, yet little is published. This study aimed to determine the position of inguinal region structures and growth of the surrounding pelvis and inguinal ligament in subjects from 0 to 19 years of age. Anonymized contrast-enhanced CT DICOM datasets of 103 patients (63 male: 40 female) aged from 0 to 19 years had left and right sides analyzed by three independent observers. Exclusion criteria were applied. Growth of the pelvis and inguinal ligament were determined using fixed bony reference points. The position of the deep inguinal ring and femoral vasculature were determined as ratio of inguinal ligament length, measured from the anterior superior iliac spine. Growth of the pelvis in vertical and horizontal dimensions and of the inguinal ligament followed a positive polynomial relationship with increasing age, with no observed increase in growth rate during puberty. From 0 to 19 years, the deep inguinal ring moved superolaterally with respect to the inguinal ligament (from 0.74 to 0.60 of the distance along the inguinal ligament) and the femoral artery and vein moved medially (from 0.50 to 0.58, and 0.61 to 0.65 of the distance along the inguinal ligament, respectively). The position of the femoral artery, vein, and deep inguinal ring followed a logarithmic relationship with age. No significant left:right side or male:female differences were observed. From 0 to 19 years of age the femoral vasculature and deep inguinal ring change position as the pelvis grows around them. Clin. Anat. 32:794-802, 2019. © 2019 Wiley Periodicals, Inc.

A novel anterior approach that involves Retzius space development between the umbilical ligaments is associated with a lower incidence of postoperative inguinal hernia in robotic radical prostatectomy.

Background: To facilitate robotic radical prostatectomy (RP), we developed a novel anterior approach that utilizes a peritoneal incision between the umbilical ligaments to develop the Retzius space without contacting the internal inguinal rings, followed by closure of this space prior to prostatectomy and vesicourethral anastomosis. This approach could decrease the incidence of postoperative inguinal hernia (IH), similar to a Retzius-sparing RP (RS-RP). We compared the incidence of IH following this novel approach with that following conventional anterior RP and RS-RP. Methods: We retrospectively reviewed 532 patients who underwent robotic RP from September 2017 to August 2022. We compared the incidence of IH following novel anterior RP (n = 153) to that following conventional anterior RP (n = 284) and RS-RP (n = 95). We also assessed the independent factors associated with postoperative IH using Cox hazard models. Results: The 12- and 24-month cumulative incidences of postoperative IH following novel anterior RP were 1.3% and 1.3%, significantly lower than those associated with conventional anterior RP (8.0% and 12.6%, p = 0.009) but not significantly different from those following RS-RP (1.1% and 2.1%, p = 0.782). In multivariate analysis, use of the novel anterior RP approach, RS-RP, and body mass index were independent factors negatively associated with the occurrence of postoperative IH. Conclusions: This novel anterior approach involves developing the Retzius space between the umbilical ligaments and closure of this space following prostatectomy and vesicourethral anastomosis. It can decrease the incidence of IH compared to the conventional anterior approach. Prospective comparative studies are necessary to confirm the benefits of this approach.

Suprapubic Fecal Fistula Due To Richter's Inguinal Hernia: A Case Report and Review of Literature.

We encountered a 55-year-old man, who presented with an orifice in the suprapubic region, through which fecal material was discharged. On physical examination, the patient was unstable. After resuscitation, thorough evaluation, and laboratory and imaging investigations, he underwent an exploratory laparotomy. The ileum was entrapped at the deep inguinal ring, and there was some pus in the pelvic cavity. The purulent material was cleaned, and anastomosis was done after the resection of the defective ileal segment. In view of the rarity of this presentation and the paucity of published articles, this case is reported here.

Novel modification of Marcy operation for indirect inguinal hernia reconstituting deep inguinal ring shutter action.

PURPOSE: The two most frequent and significant complications after inguinal hernia repair are hernia recurrence and post-herniorrhaphy chronic pain. To add anatomic and physiologic strength to the tissue repair, especially in indirect inguinal herniorrhaphy, we devised a modification of Marcy operation that can reconstitute inguinal shutter action more efficiently by changing the direction of the sutures vertical to horizontal. METHODS: During 36 months from 1st Jan. 2019, 148cases of 140 patients were operated for Indirect inguinal hernia or Pantaloon hernia (11 cases). 145 indirect inguinal herniorrhaphy were performed exclusively with author's modification of Marcy operation. Hernia recurrence during the follow-up period (3 months-36 months), and postoperative chronic pain at 3 months after herniorrhaphy were analyzed. RESULTS: 104 cases among the 145 indirect inguinal hernia (71.7%) were operated with only deep inguinal ring (DIR) reconstruction as author modified. In 41 cases (28.3%), posterior wall reconstruction was done simultaneously. There was no recurrence or reoperation case during the follow-up period. The incidence of postoperative chronic pain at postoperative 3 months of VAS greater than 3.0 was 2.2% (3 cases). CONCLUSIONS: Author's modification of Marcy operation was feasible anatomically in all indirect inguinal hernia repair, which is theoretically superior to classic Marcy operation in that repositioning the DIR more laterally and securing the obliquity and shutter action of the DIR. Result is at least not inferior in the aspect of short-term recurrence and chronic post-herniorrhaphy pain.

Transumbilical Single-Site Laparoscopic Intraperitoneal Closure of the Internal Inguinal Ring for Pediatric Inguinal Hernia.

Background: A new novel technique for pediatric inguinal hernia (PIH) repair, namely, transumbilical single-site laparoscopic intraperitoneal closure (TUSLIC) of the internal inguinal ring (IIR) with a single instrument, was introduced. The short-term follow-up of TUSLIC for PIH was compared with that of transabdominal multiple-site laparoscopic extraperitoneal closure (TAMLEC) for PIH. Methods: Descriptive variables, perioperative clinical features, and short-term outcomes were retrospectively analyzed and compared between the patients who underwent TUSLIC and those who underwent TAMLEC. Results: In total, 289 patients were enrolled in this study. Of these, 190 patients received TUSLIC, and 99 patients received TAMLEC. The descriptive variables (including sex, age, weight, and preoperative diagnosis of patients) were comparable between the two groups (P-values were 0.12, 0.71, 0.69, and 0.23, respectively). The mean operative times for unilateral hernia repair and bilateral hernia repairs in TAMLEC group were significantly less than those in TUSLIC group (P < 0.01). The values of surgical site infection, umbilical bleeding, testicular atrophy, iatrogenic ascent of the testis, and secondary hydrocele were not significantly different between the two groups. There were no suture granulomas, and recurrence occurred in TUSLIC group, though at a significantly lower rate than in TAMLEC group (P < 0.05). Conclusions: TUSLIC is a feasible, safe, and reliable minimally invasive method for PIH. Compared with TAMLEC, TUSLIC has the advantages of minimized complications and a low recurrence rate.

Laparoscopic Pediatric Inguinal Hernia Repair; Intracorporeal Purse-String Suture Using Needlescopic 2-mm Instruments.

Purpose: Two-millimeter needlescopic instruments induce minimal damage to the abdominal wall and have excellent cosmetic benefits. We aimed to evaluate the feasibility of a laparoscopic intracorporeal suture using 2-mm instruments for pediatric inguinal hernia. Methods: We retrospectively reviewed 131 patients who underwent laparoscopic repair between March 2011 and February 2017. Three trocars were used: a 5-mm umbilical trocar for a needle holder and two 2-mm trocars for a camera and a grasper. The internal ring was closed with an intracorporeal purse-string suture. A telephone interview was conducted to confirm recurrence. Results: In the 131 patients, 169 procedures were successfully performed. The ages ranged from 2 months to 14 years (mean, 52.5 months), and the mean body weight was 18.0 kg (range, 6.7~49 kg). The mean operating time was 42 minutes for the unilateral cases and 46 minutes for the bilateral inguinal hernia repairs. All the cases were completed laparoscopically without intraoperative complications. Herniotomy was not performed in all the patients except nine. A contralateral patent processus vaginalis was present in 27.3% (35/128) of the patients. During the mean follow-up period of 54.6 months, 3 recurrences (2.3%) were observed. Two recurrences were treated using laparoscopy and one using open herniorrhaphy. Hydrocele occurred in one male patient. No wound complications or umbilical hernias developed. No testicular atrophy was observed. Conclusion: This study showed that laparoscopic intracorporeal internal ring suture using 2-mm instruments for pediatric inguinal hernia was technically feasible and safe, with excellent cosmetic results.

Percutaneous Internal Ring Suturing for Indirect Inguinal Hernia in Pediatric Patients.

Many laparoscopic techniques have been developed to repair inguinal hernia in children using either an intraperitoneal or extraperitoneal approach. Percutaneous internal ring suturing (PIRS) is one of the extracorporeal suture techniques. It could be performed with comparable surgical complication or recurrence rates and excellent cosmetic results. To minimize the perioperative complications, surgical procedures of PIRS can be performed carefully with technical refinements for inguinal hernia repair in children.

The clinical significance of an incidentally detected open internal inguinal ring.

INTRODUCTION AND OBJECTIVE: An open internal inguinal ring (IIR) may be discovered incidentally either in the context of correcting pathology involving the contralateral side or at the time of surgical exploration for reasons unrelated to a patent processus vaginalis (PPV). The aim of this study is to determine the evolution of an incidentally encountered open IIR in patients undergoing laparoscopy for reasons not associated with unilateral inguinal hernia or cryptorchidism. MATERIALS AND METHODS: The authors conducted a prospective study of all patients who underwent laparoscopic surgery in the department of pediatric surgery at Agios Loukas hospital between 2004 and 2013 for various indications. Patients operated for inguinal hernia and cryptorchidism were excluded. During this period, 572 patients underwent laparoscopy for reasons not related to PPV. The median age at time of initial laparoscopy was 9,4 years (range 2 days-16 years). The IIRs were always inspected. No attempt was made to repair the open IIRs, as they were asymptomatic. Parents were informed after the operation, and instructions were given to inform us, in case that inguinal hernia symptoms manifested. The duration of the follow-up was 4 years. RESULTS: Among these 572 patients, 39 patients with 44 open IIRs were found (6,82%). From the 39 patients, 35 were male and four were female; 22 had a right open IIR, 12 had a left one, and five of them a bilateral open IIR. The median age was 7,82 years (3-14 years). Four patients were lost during follow-up. Of the remaining 35 patients with 40 open IIRs, four developed an inguinal hernia (11,43%) and were operated on with laparoscopically assisted (subcutaneous endoscopically assisted ligation [SEAL]) technique at the time of diagnosis. The study results are demonstrated on Fig. 1. DISCUSSION: The percentage of an incidentally discovered open IIR in this study is lower in comparison with studies including patients with PPV pathologies. There is a possibility, in those patients, of underlying pathology which can affect both sides. It is also lower in comparison with previous studies including younger patients. However, gender and side predominance is in accordance with most published studies. In this study group, the possibility of developing a symptomatic hernia from an asymptomatic open IIR is rather small. CONCLUSIONS: An incidentally discovered open IIR in patients without symptoms, excluding those with contralateral inguinal hernias or cryptorchidism, has relatively low chance of developing an inguinal hernia. Thus, the authors support the strategy of close follow-up in these patients.

Preliminary Assessment of a Dry-Lab Model for Laparoscopic Percutaneous Inguinal Ring Suture Training.

INTRODUCTION: Laparoscopic percutaneous inguinal ring suturing (PIRS) is a valuable technique to repair indirect inguinal hernias in children. The aim of the study was to show the preliminary results of training in an easy-to-build dry-lab model for laparoscopic PIRS technique. MATERIALS AND METHODS: The dry-lab model consists of two surgical gloves (being the smaller inside the larger). The entry of the glove is tied with a rubber letting a 5-mm trocar within it (optic). Carbon dioxide is inflated through the trocar at 8 mmHg pressure. The four long fingers of the glove simulate four internal inguinal rings. Eighteen participants without significant laparoscopic experience were asked to visualize a video showing a laparoscopic PIRS performed in a 4-year-old girl with a right inguinal hernia followed by a video showing the same technique performed in our dry-lab model. They were then asked to repeat the procedure in each of the four fingers, and the procedures were recorded. Two surgeons using the task-specific checklists (TSCs), global rating scale of operative performance (GRS), and time for the whole procedure evaluated the performance blindly. RESULTS: We found significant improvement in median TSC (P < .05) and median GRS each time the procedure was repeated (P < .05). There was significant shortening each time the procedure was repeated (P < .05), except between the third and fourth finger (P = .068). CONCLUSION: Our dry-lab model might be a good option for starting laparoscopic PIRS training.

Is Laparoscopy for Non-palpable Testes a Well-known Entity?

ABSTRACT Objective: Laparoscopy has been accepted as the best diagnostic tool and suggested as the treatment of choice for non-palpable testes cases. However, its use in unilateral non-palpable testis cases has been previously debated. Methods: The clinical records of the non-palpable testis cases that were managed with laparoscopy between January 2011 and December 2013 were retrospectively reviewed. Results: Laparoscopy was performed in 29 non-palpable testis cases. The cases were divided into three groups according to the laparoscopic findings. Orchiopexy was performed in cases with viable testes, and the internal inguinal ring was left open in these cases. Conclusion: Laparoscopy provided definitive diagnosis and was helpful in the treatment of unilateral, non-palpable testis cases. Leaving the internal inguinal ring open did not result in subsequent indirect inguinal hernia in our cases.

Laparoscopic Extracorporeal Ligation of the Internal Inguinal Ring by a Spinal Needle: a Simple Method of Hernia Repair in Children.

Laparoscopic repair has emerged recently as an alternative technique for hernia repair in children. Various methods of repair have been described. Basic principle is to close the internal inguinal ring either by intracorporeal or by extracorporeal suturing. The objective of this study is to describe and evaluate the outcome of a simple technique of internal ring closure by a spinal needle. A total of 43 hernias in 41 patients were repaired. A prolene thread was passed percutaneously around the internal inguinal ring by threading it though a spinal needle under laparoscopic control. The suture is then tied extracorporeally in the subcutaneous plane. There were 15 female and 26 male patients in the age group of 1½ to 12 years. Right-sided hernia was present in 31 cases and left-sided hernia in eight cases, and two cases had bilateral hernia. All cases were repaired successfully. There was no intraoperative or postoperative complication. This new technique has all the advantages of laparoscopic hernia repair in children (minimally invasive, less pain, less complication, and cosmesis). In addition, the method is simple and it does not need any special equipment or advanced laparoscopic skill.

Hérnia inguinal não encarcerada de ceco em mula - relato de caso / Non-strangulated inguinal hernia of the cecum in a mule - case report

Uma mula hígida, de cinco anos de idade, foi atendida portando um aumento de volume na região abdominal lateral direita, estendendo-se da região inguinal até 25cm cranial à prega pré-crural, de 60 dias de evolução, após trauma com um touro. O volume era redutível e sem dor à palpação, com presença de intestino grosso envolvido por área circular hiperecogênica na imagem ultrasonográfica. O diagnóstico foi hérnia inguinal, e a paciente foi submetida à anestesia geral inalatória para abordagem cirúrgica pela região inguinal, onde se visualizou o ceco emergindo pelo anel inguinal externo, cujo diâmetro era de aproximadamente 10cm. O ceco apresentava coloração e conteúdo normais e parte do corpo e o ápice projetavam-se cranialmente para uma bolsa de tecido subcutâneo, que foi aberta para facilitar o reposicionamento do órgão ao abdômen, bem como para ampliar o anel inguinal externo. A paciente teve alta 18 dias após o internamento. Com base neste relato, é possível concluir que a hérnia inguinal indireta não encarcerada pode se desenvolver em fêmeas equídeas após trauma. De acordo com a literatura consultada, o presente estudo é a primeira descrição desse tipo de hérnia em uma fêmea equídea e a primeira envolvendo o ceco.(AU)

A five-year-old healthy mule was referred with enlarged volume in the ventral right side of the abdomen, with 25cm in length from the inguinal region to precrural fold, developed 60 days previously due to a traumatic confrontation with a bull. The mass had no pain and was reductible on palpation and the ultrasonographic examination revealed large intestine surrounded by a hyperecoic ring. Based on these findings, the diagnosis was non incarcerated inguinal hernia. Under general anesthesia, the patient was submitted to surgery by direct approach on the inguinal region, when the cecum was seen emerging from a 10cm overture of the external inguinal ring and projecting to a subcutaneous fold cranially to the ring. This fold and the external inguinal ring were opened to facilitate the reposition of the cecum back to the abdomen. Eighteen days after the surgery the patient was discharged with a satisfactory recovery. Based on this report, it is possible to conclude that females can develop indirect non incarcerated inguinal hernias with the involvement of the cecum with good prognosis. Based on the consulted literature, this is the first report of this type of hernia in a female equine.(AU)

Five veins at the deep inguinal ring: can they reduce the chances of indirect inguinal hernia and increase the chances of varicocele? / Cinco venas en el anillo inguinal profundo. ¿pueden reducir las probabilidades de una hernia inguinal indirecta y aumentar las posibilidades de varicocele?

Complete duplication of testicular veins is a rare phenomenon. However, a few cases of duplication of gonadal veins have been reported. Here, I report a case of unusual formation and termination of the right testicular vein in an adult male cadaver. Five veins arose from the pampinniform plexus and entered the abdomen through the deep inguinal ring. The most medial among the five was large (3 mm in diameter) and it continued as a testicular vein and opened into the right edge of the inferior vena cava, 1 cm above the union of the common iliac veins. The other four veins were about 1 mm in diameter and they united to form two veins in front of the lower part of the right psoas and iliacus muscles (about 2 cm above the deep inguinal ring) and the two veins united to form upper testicular vein, 4 cm above the deep inguinal ring. This testicular vein was 3 mm in diameter and it opened into the inferior vena cava, 4 cm above the union of common iliac veins. Having five veins at deep inguinal ring might increase the chances of varicocele and decrease the chances of indirect inguinal hernia.

La duplicación completa de las venas testiculares es un fenómeno raro. Sin embargo, se han reportado algunos casos de duplicación de venas gonadales. En el presente trabajo se informa un caso de formación y terminación inusual de la vena testicular derecha en un cadáver de un hombre adulto. Cinco venas surgieron del plexo pampiniforme y penetraron en el abdomen a través del anillo inguinal profundo. El más medial entre los cinco fue de gran tamaño (3 mm de diámetro) y continuó como una vena testicular y se abrió hacia el margen derecho de la vena cava inferior, 1 cm por encima de la unión de las venas ilíacas comunes. Las cuatro venas restantes eran de 1 mm de diámetro aproximadamente, y se unieron para formar dos venas frente a la parte inferior de los músculos psoas e ilíaco derechos (aproximadamente 2 cm por encima del anillo inguinal profundo). Se unieron dos venas para formar la vena testicular superior, la cual medía 3 mm de diámetro y se abría hacia la vena cava inferior, 4 cm por encima de la unión de las venas ilíacas comunes. Cinco venas en el anillo inguinal profundo podrían aumentar las posibilidades de varicocele y disminuir las posibilidades de una hernia inguinal indirecta.

Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing

The aim of this study was to explore the clinical efficacy of a novel retrograde puncture approach to establish a preperitoneal space for laparoscopic direct inguinal hernia repair with inguinal ring suturing. Forty-two patients who underwent laparoscopic inguinal hernia repair with retrograde puncture for preperitoneal space establishment as well as inguinal ring suturing between August 2013 and March 2014 at our hospital were enrolled. Preperitoneal space was successfully established in all patients, with a mean establishment time of 6 min. Laparoscopic repairs were successful in all patients, with a mean surgical time of 26±15.1 min. Mean postoperative hospitalization duration was 3.0±0.7 days. Two patients suffered from postoperative local hematomas, which were relieved after puncturing and drainage. Four patients had short-term local pain. There were no cases of chronic pain. Patients were followed up for 6 months to 1 year, and no recurrence was observed. Our results demonstrate that preperitoneal space established by the retrograde puncture technique can be successfully used in adult laparoscopic hernioplasty to avoid intraoperative mesh fixation, and thus reduce medical costs.

Histología del anillo inguinal interno en pacientes con hernia inguinal indirecta: serie de casos observacional y descriptiva / Age associated changes in the histology of indirect inguinal hernia rings

Background: This study has the purpose to investigate the microscopic basic histological structure of the internal inguinal ring in patients operated on for primary indirect inguinal hernia. Patients and Methods: A sample of 72 consecutive male patients older than 15 years-of-age with unilateral inguinal hernia submitted to elective surgery was studied. The primary outcome measure was the histological findings of the internal inguinal ring. All samples were processed only by histochemical techniques. Patients were divided in 3 groups according to age. Group I: patients between 15 and 40 years-of-age. Group II: patients between 41 and 70 years-of-age. Group III: patients older than 71 years. Results: All samples from the internal inguinal ring were constituted by fibrous fascial tissue with elastic fibers which were thicker in younger patients and thinner in older patients. Adipose tissue between elastic fibers was absent in younger patients and was abundant in older patients. Vascular sclerosis was minimal in Group I, moderate in Group II, and important in Group III. Acute or chronic inflammatory cells were absent in all patients. Conclusions: The histological characteristics of the internal inguinal ring in patients with indirect inguinal hernia consist on reduced density and thickness of elastic fibers and increased adipose tissue between elastic fibers. Vascular sclerosis was more severe as the age of the patients increased. These histological changes were related to normal aging.

Introducción: El presente estudio tiene como objetivo investigar la estructura histológica básica del anillo inguinal interno en pacientes operados por hernia inguinal indirecta primaria. Pacientes y Métodos: Se estudió una muestra de 72 pacientes consecutivos mayores de 15 años de edad con hernia inguinal indirecta unilateral sometidos a cirugía electiva. El objetivo principal fue la histología básica del anillo inguinal interno. Las muestras fueron procesadas con técnicas histoquímicas. Los pacientes se dividieron en 3 grupos de acuerdo a la edad. Grupo I: pacientes entre 15 y 40 años de edad. Grupo II: pacientes entre 41 y 70 años. Grupo III: pacientes mayores de 71 años de edad. Resultados: Todas las muestras histológicas del anillo inguinal estuvieron constituidas por tejido fascial fibroso con fibras elásticas gruesas en pacientes jóvenes y delgadas en pacientes mayores. La esclerosis vascular fue mínima en el grupo I, moderada en el grupo II e importante en el grupo III. No se encontraron células inflamatorias agudas o crónicas. Conclusiones: Las características histológicas básicas del anillo inguinal interno consisten en fibras elásticas que disminuyen su densidad y se adelgazan con la edad y en un aumento simultáneo del tejido adiposo entre estas fibras. La esclerosis vascular se presenta y es más severa en la medida que la edad de los pacientes aumenta. Estos cambios histológicos se relacionan al envejecimiento normal.

Protocolo de manejo de hernia inguinal en el servicio de cirugía general del hospital Dr. Teodoro Maldonado Carbo, Guayaquil / Protocol of handling of inguinal hernia in the service of general surgery of the Hospital Dr. Teodoro Maldonado Carbo, Guayaquil

Se propone un protocolo de manejo para la patología herniaria en el Servicio de Cirugía General del Hospital Dr. Teodoro Maldonado Carbo de Guayaquil, cuyo propósito es unificar criterios para el manejo de esta patología tan frecuente en nuestro medio; siendo el objetivo principal disminuir las recurrencias, que fluctúan entre 4 y 6% según las estadísticas mundiales; independientemente de las variables atribuibles al equipo quirúrgico y evaluación exacta de cada caso.Como conclusiones podemos mencionar que la causa principal de recidiva es la tensión en la línea de sutura y que la técnica de Shouldice es la apropiada cuando existe defecto de la pared posterior. Este artículo resume una propuesta para el manejo de esta patología muy frecuente como resultado de la experiencia en este servicio.

We intend to propose a protocol for handling a hernial pathology in the Service of General Surgery of the Hospital of the I.E.S.S of Guayaquil. Our purpose is to unify criteria for the handling of this pathology that is very frequent in our society. Our main objective is to lower recurrences that are between 4 and 6% according to world statistics independent from variables such as surgery equipment and the evaluation of each case.As a conclusion the main cause of recurrence is the suture line tension. We also want to conclude that the Shouldice technique should be used when there is a defect on the posterior wall. This article summarizes a proposal of the handling of this pathology that is very frequent at our service.