J Korean Assoc Pediatr Surg.  2018 Jun;24(1):5-9. 10.13029/jkaps.2018.24.1.5.

Is Preoperative Ultrasonography Necessary in Pediatric Inguinal Hernia?

• Han JW
• Youn JK
• Yang HB
• Oh C
• Kim HY
• Jung SE

• KMID: 2415879
• DOI: http://doi.org/10.13029/jkaps.2018.24.1.5

Abstract

PURPOSE
Preoperative ultrasonography (USG) in pediatric inguinal hernia has controversy. In this study, we analyzed the cases of pediatric inguinal hernia with/without preoperative USG and discussed whether USG is necessary.
METHODS
We reviewed medical records of 1,441 patients who underwent inguinal hernia repair in Seoul National University Children's Hospital between January 2011 and August 2016 retrospectively.
RESULTS
Male were 69.3% and age at operation was 37.8±36.5 months old. There were 150 patients (10.4%) performed USG preoperatively. The department ordered to perform USG included department of surgery (n=71), emergency medicine (n=42), pediatrics (n=26), urology (n=10) and outside hospital (n=1). The reasons of performing USG included evaluation for hernia laterality (n=82), incarceration (n=28), testis (n=15), request of parents (n=14), scrotal mass (n=6) and incidentally found during evaluation for another disease (n=5). Excepting 5 cases of incidental finding, of 145 cases with USG, 12 (8.3%) cases changed the surgical plan; change to bilateral repair from unilateral repair (n=5), emergency operation due to incarceration (n=4) which include 1 salpingo-oophorectomy, 1 open abdomen surgery and 2 hernia repair after reduction of ovary, change to co-operation of orchiopexy (n=2) and change to laparoscopic surgery from open surgery due to herniation of both ovaries into one inguinal canal (n=1). In group without USG (n=1,291), 5 patients (0.4%) had unexpected problems during operation; 2 co-operation of orchiopexy because of transverse testicular ectopia (n=1) and right undescended testis (n=1), 2 hypertrophy of major labia and 1 retroperitoneal lymphangioma at inguinal area misdiagnosed as inguinal hernia.
CONCLUSION
It was difficult to interpret the meaning of preoperative USG because not all patients had performed it. In this study, 10.4% of patients performed USG and 8.3% of them changed surgical plan. About 0.4% of patients without preoperative USG would have benefited from it for surgery if they had performed it. Since the percentage is too low, it is unreasonable to conclude that USG has diagnostic utility in inguinal hernia in this study.

Keyword

Hernia; Inguinal; Ultrasonography; Child

MeSH Terms

Abdomen
Child
Cryptorchidism
Emergencies
Emergency Medicine
Female
Hernia
Hernia, Inguinal*
Herniorrhaphy
Humans
Hypertrophy
Incidental Findings
Inguinal Canal
Laparoscopy
Lymphangioma
Male
Medical Records
Orchiopexy
Ovary
Parents
Pediatrics
Retrospective Studies
Seoul
Testis
Ultrasonography*
Urology

Figure

• 

  Fig. 1 Patients with and without preoperative ultrasonography (USG).

• 

  Fig. 2 Herniation of both ovaries into unilateral inguinal canal. (A) Before reduction. (B) After reduction.

• 

  Fig. 3 Transverse testicular ectopia with persistent Mullerian duct syndrome. (A) Left testis at right inguinal internal ring. (B) Reduction of right testis.

• 

  Fig. 4 Retroperitoneal lymphangioma which was misdiagnosed as inguinal hernia (arrow).

Reference

1. Chung SY. Indirect inguinal hernia in pediatric patients. J Korean Assoc Pediatr Surg. 2010; 16:101–107.

2. Meena D, Jhuria R, Saxena S, Saini U. Inguinoscrotal hernia in infants: three case reports in ultrasound diagnosis. Indian J Radiol Imaging. 2017; 27:78–81.

3. Lee JE, Choi KJ. A clinical study of pediatric inguinal hernia before and after using ultrasonography for diagnosis. J Korean Assoc Pediatr Surg. 2004; 10:131–135.

4. Zaidi SH, Rahman JU, Siddiqui TS, Rehman HU, Ahmed N, Fraz MO. Exploration of the contralateral groin in paediatric inguinal hernia or hydrocele based on ultrasound findings: is it justified? J Ayub Med Coll Abbottabad. 2017; 29:26–29.

5. Kwon O, Jung J, Park J, Chang S. Ultrasonographic evaluation in patients with inguinal hernia. J Korean Assoc Pediatr Surg. 2002; 8:16–22.

6. Sameshima YT, Yamanari MG, Silva MA, Neto MJ, Funari MB. The challenging sonographic inguinal canal evaluation in neonates and children: an update of differential diagnoses. Pediatr Radiol. 2017; 47:461–472.

7. Hasanuzzaman SM, Chowdhury LH, Sarker RN, Bari MS, Talukder SA, Islam MK. Ultrasonographic evaluation of contralateral exploration of patent processus vaginalis in unilateral inguinal hernia. Mymensingh Med J. 2011; 20:192–196.

8. Hata S, Takahashi Y, Nakamura T, Suzuki R, Kitada M, Shimano T. Preoperative sonographic evaluation is a useful method of detecting contralateral patent processus vaginalis in pediatric patients with unilateral inguinal hernia. J Pediatr Surg. 2004; 39:1396–1399.

9. Kim SM, Kim DY, Kim SY, Kim SC, Kim WK, Kim JE, et al. Trend (in 2005) of repair of inguinal hernia in children in Korea: a national survey by the Korean Association of Pediatric Surgeons in 2005. J Korean Assoc Pediatr Surg. 2006; 12:155–166.