Direct inguinal hernia in infancy and childhood

Abstract

In 16 years in a provincial paediatric surgical practice, 19 direct inguinal hernias in 14 patients have been encountered amongst over 1,600 inguinal hernia operations. Nearly one-half of these presented as recurrent hernias. Five types of direct hernia were recognized: direct hernia with distinct sac (1 patient); hernia en pantaloon with associated indirect sac (1 patient); sliding direct hernia (1 patient); direct weakness with no indirect sac and no distinct direct sac; and giant indirect hernia with such a huge sac that the whole of the posterior wall of the inguinal canal is encroached upon and weakened. Direct inguinal hernia can be suspected clinically, but positive diagnosis is difficult. It should be suspected at operation if no significant indirect sac is found. Repair of the transversalis fascia seems to be effective surgical treatment, with no known recurrence in this series.