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Hernia
Published in: Hernia 2/2014

01-04-2014 | Original Article

Hernia sac of indirect inguinal hernia: invagination, excision, or ligation?

Authors: I. Othman, H. A. Hady

Published in: Hernia | Issue 2/2014

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Abstract

This study compares the effect of invaginating excision of hernia sac without ligation with the traditional method of high ligation of the hernia sac on postoperative pain and recurrence.

Patients and methods

This multicenter prospective randomized study included 152 patients with 167 primary indirect inguinal hernias. In group I (54 hernias), the sac was not opened and was inverted with the finger into the peritoneal cavity. In group E (56 hernias), the sac was excised at the neck without ligation. In group L (57 hernias), the sac was transfixed at the neck and excised in the traditional manner. The repair of the posterior wall of the inguinal canal was done according to Lichtenstein tension-free technique. Mean length of follow-up was 81.50 ± 22.34, 79.35 ± 26.76, and 77.83 ± 21.26 months, respectively.

Results

Postoperative seroma occurred in 1 patient (0.60 %) in group E and 1 patient (0.60 %) in group L. Surgical site infection occurred in 2 patients (1.20 %) in group I, 1 patient (0.60 %) in group E, and 2 patients (1.20 %) in group L. Mean postoperative pain score was 3.04 ± 2.11, 3.98 ± 2.33 and 4.06 ± 2.43, respectively (p: 0.049). Chronic pain occurred in 3 patients in group I (1.80 %), 3 patients in group E (1.80 %), and 5 patients in group L (3.00 %) (p: 0.749). The difference between the complications in three groups was statistically insignificant (p: 0.887). Hernia recurrence occurred in 3 patients (1.80 %) in group I, 1 patient (0.60 %) in group E, and 1 patient (0.60 %) in group L (p: 0.429).

Conclusion

Invagination and excision of the hernia sac do not have adverse effects on repair integrity. They limit the dissection and reduce the morbidity and risk of injury to the spermatic cord and surrounded structures. They are safer and more appropriate for repair of sliding hernia. Ligation of the hernia sac in inguinal hernia surgery is not only unnecessary and time consuming but also leads to increased postoperative pain. Recurrence rates are statistically unaffected by not ligating the sac.
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Metadata
Title
Hernia sac of indirect inguinal hernia: invagination, excision, or ligation?
Authors
I. Othman
H. A. Hady
Publication date
01-04-2014
Publisher
Springer Paris
Published in
Hernia / Issue 2/2014
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-013-1081-z

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