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Pediatric Surgical Procedures – An Updated Guide – Volume I
91
indicate a successful or unsuccessful outcome [85]. Mechanical ventilation was necessary for 34% of preterm newborns after herniorrhaphy, according to Gollin et al.,
because of the minimal risk of a second anesthetic utilizing contemporary methods.
Glick et al. [7] have advocated phased treatment of large bilateral hernias in the
elective context. In an emergency situation, it may be necessary to utilize a silo, like
the one used for abdominal wall abnormalities, to reduce pressure in the abdominal
compartment and gradually bring the intestines back to the abdomen.
.. Chronic pain
Chronic discomfort is a typical and concerning side effect that may occur after
inguinal hernia surgery. Repairing a groin hernia may cause persistent discomfort for
over 16% of patients. When a patient has persistent pain after inguinal hernia surgery,
the exact source of that discomfort may be difficult to pin down due to the complexity
of the problem. Perioperative nerve injuries, or nerves that become caught or injured
by sutures, are two potential sources of pain during surgery. Drawing on current clinical practices and best practice standards, this study aimed to provide a synopsis of
therapy options for patients experiencing persistent discomfort after inguinal hernia
repair. The first step in providing the best care for patients experiencing persistent
discomfort after inguinal hernia surgery is to conduct a comprehensive clinical
evaluation to identify and eliminate any potential complications or recurrences of the
condition. It is advised to treat patients on a sliding scale. Assuming the patient is able
to do so, the next step is to try cautious waiting, then systemic opioids, increasing to
blocks, and finally, surgery. A triple neurectomy is the surgical procedure used [86].
.. Mortality
The risk of mortality, the most serious consequence of inguinal hernia repair, is
very low in industrialized nations, occurring at an incidence of 0.004%. Nevertheless,
in developing nations, it may be a hundred times more. Inguinal hernia repair-related
mortality is due to hernia-related complications or other risk factors, such as preterm or
heart disease, which may occur simultaneously [87]. Age less than 6 months and surgeon
and anesthesiologist inexperience in pediatric surgery are the main risk factors [9].
. Discussion and conclusions
International research indicates that open repair is the most effective method for
managing inguinal hernias. Unlike a laparoscopic procedure, an open repair does not
compromise the abdominal cavity’s integrity. Nevertheless, a growing number of
surgeons have advocated for laparoscopic pediatric repair since its debut in general
surgery 30years ago for pediatric inguinal hernia repair, particularly in the last
decade [70].
To fix an open hernia, surgeons must first make an incision in the inguinal region,
then cut the sac open, remove the spermatic cord, and then ligate the sac. This operation has been associated with testicular problems such as ascending testis, hydrocele,
and atrophy, which might be caused by damage to the spermatic cord or by issues that
arise after manipulating the testis and spermatic cord. The treatment of ascending
testis hydrocele requires further surgical procedures. On top of that, problems with
the testicles might cause infertility down the road [88].
Inguinal Hernia in Children: A Literature Review
DOI: http://dx.doi.org/10.5772/intechopen.115548
92
In 2022, Bada et al. [89] conducted a meta-analysis and systematic review of studies published over the last decade. The end outcome was that with the total number
of patients covered in the 27 publications (91,653), 26,920 being LH, and 64,733
being OH, the total amount of time needed to complete the operation (OT) was not
significantly different. By breaking the data down by gender, they found that the OT
for LH was shorter for unilateral and bilateral hernias but longer for female unilateral
hernias. The rate of recurrence was comparable. Results showed fewer problems in
the LH group. The average incidence of contralateral patent processus vaginalis was
39.61%, and a substantial reduction in contralateral metachronous hernia was found
upon its closure.
Cheng et al.’s [88] results demonstrated a shorter operation time, a reduced
frequency of ascending testis and metachronous hernia, and a reduction in overall
surgical complications in boys treated with the extraperitoneal technique (LHE). The
rates of hydrocele, testicular atrophy, and ipsilateral hernia recurrence were also not
different between the groups who had LHE and those that underwent open hernia
surgery. Consequently, compared to open hernia surgery, LHE may be a safe and
practical option for treating male juvenile inguinal hernias, and there is no evidence
that it increases the risk of testicular problems [12].
According to Zubaidi et al.’s systematic review [90], which included 245 OH and
339 LH out of a total of 584 participants, the OH showed worse complications more
frequently overall. There were no discernible group differences when each complication was evaluated separately. The LH group had a shorter hospital stay compared to
the OH group.
In accordance with Liu et al.’s retrospective review [91], there were 202 instances
of unilateral inguinal hernia repair and 43 occurrences of bilateral surgery in the OH
group. In the LH group, 136 patients had bilateral hernias repaired, while 168 patients
had unilateral ones. While the amount of time spent operating was significantly different between the two groups, neither the length of time spent in the hospital after
surgery nor the frequency of ipsilateral recurrent hernia differed. Compared to the
OHR group, the LH group had a much decreased incidence of surgical site infection
and metachronous contralateral hernia (MCH).
Finally, according to Maat et al.’s meta-analysis [12], a total of 358 individuals
had their hernias repaired openly, while 375 had laparoscopic (LH) surgery. The
groups did not vary with respect to complications, recurrences, or MCH. Due to LH,
the time required for the bilateral procedure was reduced. Recovery, hospital stay,
and the amount of time needed for a unilateral procedure were all around the same.
Postoperative pain and wound cosmesis were not well evaluated, and there was a
significant amount of variability across the studies that were included. Results from
subgroup studies showed that intracorporeal suturing resulted in a shorter hospital
stay and fewer problems than extracorporeal suturing, whereas unilateral operations
took less time and required less surgical intervention.
Conflict of interests
Authors declare of not having any conflict of interests.
Inguinal Hernia in Children: A Literature Review
DOI: http://dx.doi.org/10.5772/intechopen.115548
93
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100
Chapter 5
Repair Using the Burnia Te
chnique
SabriyeDayi
Abstract
Inguinal hernia repair is one of the most frequently performed surgeries in pediatric surgery clinics. The primary objective of this surgery is to close the inguinal hernia
sac. Several techniques have been established for inguinal hernia repair, and the efforts
to develop more techniques continue. Minimally invasive procedures are preferred.
The Burnia technique for repairing girls’ hernias is one of the latest approaches and
offers advantages such as applicability, minimal recurrence, evaluation of the opposite
inguinal canal, and simpler training. In the Burnia technique, the peritoneum at the
inner mouth of the inguinal canal is thermally cauterized, which ensures the formation
of fibrosis. In this section, how the Burnia technique is performed will be explained.
Keywords: inguinal hernia, laparoscopy, Burnia, girl, herniorrhaphy, sutureless
inguinal hernia repair, children
. Introduction
. Highlights
. Inguinal hernia repair is one of the most frequently performed pediatric surgeries.
. A wide variety of minimally invasive procedures are used to repair inguinal
hernias in children.
. Peritoneal traumas reportedly play essential roles in the obliteration of the inter-
nal inguinal ring.
. In the Burnia technique, the peritoneum at the inner mouth of the inguinal canal
is thermally cauterized, ensuring fibrosis formation that prevents recurrence.
. Inguinal hernia repair history
Inguinal hernia repair is one of the most frequently performed pediatric surgeries. The
main objective of this surgery is to close the inguinal hernia sac to prevent the abdominal
organs from entering it. The first surgery of this kind dates back to BC. In ,
Marcy described the high ligation of the hernial sac, which continues to be used today [].
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