Omitting ligation of the hernia sac during herniotomy and orchiopexy in children

Abstract

Background 
Inguinal hernia is one of the commonest conditions in pediatric surgical practice requiring surgical intervention. Herniotomy after high ligation of the peritoneal hernial sac is the standard procedure performed to prevent recurrence. The conventional and accepted technique of orchiopexy recommends that ligation of the hernial sac is mandatory for prevention of postoperative development of hernia.  
Objectives of the study 
This study was planned to study the effects of non-ligation of the sac on the results of herniotomy in the pediatric age group. 
Patient and method 
This is a prospective study of 140 patients under the age of 6 years undergoing surgeries for indirect inguinal hernias (90 patients, all males) and orchiopexy surgeries (50 patients) over a period of two years (October 2008-october 2010) in Baquba teaching hospital. The age range of the patients was 4 months up to 6 years.
The hernia sac wasn’t ligated but it is merely amputated and left to be retracted out of the sight. All patients were followed for 2-2.5 year Results
For patients operated on for undescended testicle, no single patient developed inguinal hernia. 
For the patients operated on for indirect inguinal hernia 2 patients (2.22%) developed recurrence of their hernia. 
Conclusion 
We conclude that ligation of hernia sac is not necessary in achieving surgeries for indirect inguinal hernias and during inguinal orchiopexy. Cancelling ligation of the sac will save time and gives extra length for the cord in orchiopexy surgeries.