Hernia repairs - treatment of choice in teenagers - Forum

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Grandpa Phil

Hernia repairs - treatment of choice in teenagers - Ärzteforum

Post#1 »

I am curious, as we are again on the subject of hernia repairs, as to when you would consider just doing a herniotomy for an adult indirect hernia. There is no dispute that this remains the treatment of choice in children, but in teenagers, or a bit older, or just a bit older. When does one decide to do more than a herniotomy, age based, hernia size - (but some children's hernias are also HUGE relative to the patient), condition of tissues (some adults have excellent tissues unyet we bolster them with foreign materials or drag in other tissues to add strength).

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Re: Hernia repairs - treatment of choice in teenagers - Ärzteforum

Post#2 »

In YOUNG ADULTS' INDIRECT hernia- I do herniotomy only. If the internal ring is however "stretched-dilated" I would "fill' is with a mesh umbrella.

I always feel the posterior wall of the canal -if inadequate (which is rare in young adults) I would proceed with a Lichtenstein. As Nyhus said: there is no place for "ONE REPAIR FOR ALL" but it must be tailored to the hernia.


Re: Hernia repairs - treatment of choice in teenagers - Ärzteforum

Post#3 »

In children you don't "repair" the hernia in the same sense as in adults. The only one thing to be done is just to free the sac and put it back to the abdominal cavity, for the defect is a persistent peritoneo-vaginal duct. There's not tissues damage, unless you find no posterior wall or a very big deep inguinal ring, rare situations. Why to "repair" it in older children or young adults?, because there already exists tissue damage, in other words, or the inguinal ring is wide in the indirect hernia or the posterior wall is weak in the direct ones. The use of meshs is still controversial. I prefer the use of methods without meshs, especially in young people. Nobody knows what happens in the long term with the function of the vas deferens in contact with foreign materials. I think that it should be preferable to do a second operation if a recurrence occurs, instead of putting a mesh in a young man in the first op. Shouldice method shows the same recurrence rate of the methods with the use of meshs, so it is a very good option.


Re: Hernia repairs - treatment of choice in teenagers - Ärzteforum

Post#4 »

We think that when you are treating a sort of congenital indirect hernia of relatively small volume in a young patient, let's say up to 20 yo, whose anatomical findings are normal and the posterior wall shows indemnity, you should do herniotomy with high ligation of the sac and stretching of the internal ring without doing anything else.

Because we ask, why dismantle a normal anatomical structure and replace it with a mesh or another kind of repair?

Perhaps Dr. Parvis Amid would not agree with this as he thinks that hernia is a genetical fault in the quality of cholagenous tissue and probably these youngsters should be also repaired with a mesh in order to treat and prevent the appearance of another hernia during his lifetime.

But we don't know what may happen with a mesh in place during more than 40 or 50 years...Would the spermatic cord and the testicle suffer?

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A Doctor

Re: Hernia repairs - treatment of choice in teenagers - Ärzteforum

Post#5 »

The discussion of hernia repair seems to have met with many different opinions. On the one hand there are those who favor a nonoperative approach in anyone who does not have a hernia defect readily palpable on physical exam. Others favor a "look and see" approach even if a hernia is not readily apparent on exam. A subset of these would do nothing if exploration (either open or laparoscopic) revealed no evidence of hernia defect, while the rest would procede on with the repair regardless.

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