First one with correct answer with justification win.

 

[size=20px]A six-month old boy presents with a reducible right inguinal hernia. Which one of the following hernia repair operative techniques has a lowest rate of wound infection?

 

A open high ligation and resection of sac

 

B laparoscopic high ligation of sac

 

C total extraperitoneal (TEP) hernia repair

 

D transabdominal preperitoneal (TAPP) hernia repair[/size]

B

B

PPV is the primary pathology in a congenital inguinal hernia. So full circumferential resection of PPV is the curative procedure, after reduction of the contents of the sac whichever approach open or laparoscopic is undertaken to prevent recurrence. Ligation of the proximal resected part or not of PPV is the procedure depends on the surgeons choice, most of course will ligate it.

correct answer

B laparoscopic high ligation of sac

 

Pediatric laparoscopic inguinal hernia repair with high ligation, using several techniques, has recently become a popular approach. This approach has been controversial specifically regarding hernia recurrence. However, after a number of recent modifications to the surgical technique, surgeons are reporting very good results. Several recent reports with a large number of patients and adequate follow-up have suggested that this approach results in hernia recurrence rates (0.5 to 1.5%) that are comparable to the traditional open hernia repair with high ligation and sac resection. One recent large retrospective meta-analysis also indicates that complications, other than recurrence, are statistically significantly less (p< 0.01) than the traditional open approach.

 

There is no evidence that a TEP or TAPP hernia repair is appropriate in children.