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A tailored approach for the treatment of indirect inguinal hernia in adults—an old problem revisited

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Abstract

Purpose

A patent processus vaginalis peritonei (PPV) presents typically as an indirect hernia with an intact inguinal canal floor during childhood. Little is known however about PPV in adults and its best treatment.

Methods

A cohort study included all consecutive patients admitted for ambulatory open hernia repair. In patients with a PPV, demographics, hernia characteristics, and outcome were prospectively assessed. Annulorrhaphy was the treatment of choice in patients with an internal inguinal ring diameter of <30 mm.

Results

Between 1998 and 2006, 92 PPVs (two bilateral) were diagnosed in 676 open hernia repairs (incidence of 14%). Eighty nine of the 90 patients were males, the median age was 34 years (range: 17–85). A PPV was right-sided in 67% and partially obliterated in 66%. Forty-one patients had an annulorrhaphy and 51 patients had a tension-free mesh repair. The median operation time was significantly shorter in the annulorrhaphy group (38 vs. 48 min, P<.0001). In a median follow-up period of 56 months (27–128), both groups did not differ concerning recurrence (1/41 vs. 2/51), chronic pain (3/41 vs. 4/51), and hypoesthesia (5/41 vs. 9/51). There was however a clear trend to less neuropathic symptoms in favor of annulorrhaphy (0/41 vs. 5/51, P < 0.066).

Conclusions

PPV occurs in 14% of adults undergoing hernia repair. In selected patients, annulorrhaphy takes less time and is associated with equally low recurrence but less potential for neuropathic symptoms.

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Abbreviations

PPV:

Patent processus vaginalis peritonei

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Acknowledgments

The authors thank Giustina Mariotti for her valuable help in data management and Philippe Clavel for drawing and providing Fig. 1a–d.

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Authors and Affiliations

  1. Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Martin Hübner, Markus Schäfer, Hicham Raiss, Nicolas Demartines & Henri Vuilleumier

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  1. Martin Hübner
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  2. Markus Schäfer
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  3. Hicham Raiss
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  4. Nicolas Demartines
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  5. Henri Vuilleumier
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Correspondence to Henri Vuilleumier.

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Hübner, M., Schäfer, M., Raiss, H. et al. A tailored approach for the treatment of indirect inguinal hernia in adults—an old problem revisited. Langenbecks Arch Surg 396, 187–192 (2011). https://doi.org/10.1007/s00423-010-0635-0

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  • DOI: https://doi.org/10.1007/s00423-010-0635-0

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