Хирургическое лечение мальчиков с грыжами пахового канала. Анализ пятилетнего опыта

Introduction. Currently the surgical treatment of inguinal hernias in children is usually a high ligation of the hernia sac without the separation of its distal portion or plastic reconstruction of the inguinal canal. This technique is considered the treatment of choice as it has brought down the incidence of post-operative hernias and testicular atrophy. However, the issues of approach to the selection of a conservative treatment strategy and the role played by instrumental examination methods used to determine indications for surgical treatment remain controversial. Materials and methods. This paper presents a retrospective analysis of 684 clinical cases followed up at the Yaroslavl Regional Children’s Teaching Hospital. The study included boys aged one month to 17 years who were treated for inguinal and inguinoscrotal hernias in 2011-2015. Results and discussion. 89 patients (10.3%) were hospitalised with incarcerated inguinal and inguinoscrotal hernias in the period under review. Of these, in 86 patients, when the incarceration lasted under 12 hours, conservative treatment attempts were undertaken. Hernia reduction was achieved without any direct manipulation on the hernia sac in 10 boys (11.6%). Attempts of manual hernia reduction were undertaken in the remaining 56 children (65.1%); these resulted in successful outcomes in 47 patients (83.9%). Emergency surgical repair of incarcerated hernias was performed in 23 cases (3.1%). No patients with incarcerated hernias were older than seven years. 45 out of 183 boys (29.5%) had scrotal oedemas and haematomas in the early post-operative period following planned hernia repair surgeries. Conclusion.  In the majority of patients hospitalised early the conservative hernia reduction approach was effective and resulted in fewer emergency hernia repair surgeries. Ultrasound examination of inguinal canal may be considered as a method of screening for asymptomatic hernias.