Laparoscopic repair of sliding inguinal hernia in female children.

PURPOSE: To evaluate the safety and feasibility of laparoscopic repair of sliding inguinal hernia in female children. METHODS: Laparoscopic percutaneous extraperitoneal closure (LPEC) was performed in 482 female inguinal hernia children between 2006 and 2015. Fourteen of these patients were associated with sliding inguinal hernia, and these 14 patients were enrolled and reviewed retrospectively. RESULTS: The mean age and the body weight at the operation was 9.6 months and 7.8 kg. Seven patients required the reduction of the ovary under general anesthesia. Laparoscopy, however, revealed that five patients had severe sliding of fallopian tube into the inguinal canal. One of these five patients received a simple LPEC, but developed the recurrence due to the low ligation of the hernia sac, and needed the second hernia repair under inguinal approach. Other four patients with fallopian tube sliding required the dissection of the fallopian tube and peritoneal repair, or the conversion to inguinal approach; therefore they had longer surgical time compared to those without fallopian tube sliding. CONCLUSION: LPEC is safe and feasible for the sliding inguinal hernia repair except the cases with fallopian tube sliding. Patients with fallopian tube sliding required additional procedure or conversion to inguinal approach.

Case Report: Robotic-Assisted Minimally Invasive Repair of a Direct Sliding Left Inguinal Hernia Containing Bladder and Colon.

A direct sliding inguinal hernia descends through the superficial inguinal ring and encroaches on nearby organ structures, such as the bladder. This type of hernia is rare with a 2-5% incidence and occurs due to a weakness within the lower abdominal wall, usually associated with advancing age, that permits the distal colon to descend into the inguinal canal. Direct sliding inguinal hernias are a rare subset of inguinal hernias that require meticulous dissection due to their incorporation of nearby organs such as the bladder or colon. Few cases report repair of these hernias laparoscopically; however, the use of a hybrid laparoscopic/open approach has not been extensively documented and it may be beneficial to explore the use of this approach in inguinal hernia repair.  We present a case of a robotic-assisted minimally invasive repair of a direct sliding inguinal hernia in an 85-year-old male. He initially presented to the emergency department with left-sided groin pain and imaging revealed he had a direct sliding inguinal hernia that incorporated the bladder wall. He was admitted to surgery for a robotic-assisted minimally invasive inguinal hernia repair with mesh. During the surgery, after seeing the extent at which the hernia sac incorporated the bladder wall, the procedure was converted to an open approach to perform the remainder of the reduction; however the robot was reintroduced for mesh placement. Post-operatively, the patient experienced mild incisional abdominal pain with return of bowel function on day four and was discharged that same day.

Neonatal inguinal hernias containing the uterus: a case report on changes in uterine position.

A female newborn weighing 542 g and delivered at 27 weeks gestation presented with bilateral inguinal hernias while in the neonatal intensive care unit. Ultrasonography confirmed herniation of the uterus into the right inguinal hernia without signs of incarceration. Due to the absence of complications, she was discharged and scheduled for follow-up at the outpatient clinic. At 11 months of age, a subsequent ultrasonography showed only omental herniation, with no evidence of uterine prolapse. When she reached 1 year of age, a laparoscopic percutaneous extraperitoneal closure procedure was performed. During the surgery, it was observed that the uterus and fallopian tubes were located near the hernia orifice, but no clear prolapse was detected. The procedure concluded safely with successful high ligation. It has noted that in cases of uterine prolapse hernias, the uterus tends to recede as the child grows, which supports the decision to delay surgery for improved safety.

Rarity in conspicuity-Ultrasound diagnosis of sliding left inguinal hernia through canal of Nuck with uterus, fallopian tubes and ovaries.

We present a case of a one month old female infant who presented with left inguinal swelling. She was prematurely born at 32 weeks of gestational age. Preoperative ultrasound showed features of sliding indirect inguinal hernia with both ovaries, fallopian tubes and uterus; which were also evident per operatively. Patient underwent successful hernia repair and uneventful post-operative period. Patient is on follow up currently. In conclusion, we attempt to highlight the exiguous prevalence of inguinal hernia with uterus, fallopian tubes and ovaries; which has been sparsely reported in the literature and also the importance of preoperative of sonography.

Inguinal hernias containing the uterus: a case series of 7 female children.

BACKGROUND: Hernia uteri inguinale (HUI), or uterus-containing inguinal hernia, is an extremely rare condition in which the uterus and uterine adnexa are found in the inguinal hernial sac in female infants. The uterus may be free within the sac adherent to the wall by adhesions or a true sliding component. However, in true sliding-type HUI, one of the walls of the hernia sac is formed by the uterus itself. PATIENTS AND METHODS: The medical records for all female children with inguinal hernia who were operated from 1999 through 2010 were reviewed retrospectively (n = 3100). RESULTS: Among these patients, we identified seven cases of HUI in infants with a normal female karyotype. The incidence of HUI was 0.23%. Patients were discharged on the postoperative 1st day with no complications. CONCLUSIONS: Surgeons should be aware of the possibility of presence of the uterus or another organ in the hernial sac in phenotypic female children, and sliding components should be replaced carefully into the abdomen to prevent any damage.