Patent Processus Vaginalis
Everything in the library about patent processus vaginalis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
4 items
Laparoscopic Pediatric Hernia Repair: Online Course 2017
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This was a half-day course focused on teaching the fine points of a the laparoscopic pediatric hernia repair led by Drs Ian Mitchell, Todd Ponsky, Jeff Gander, Sophia Abdulhai, Abdulraouf Lamoshi, Louis Seya.We presented many of the differ
video102:10 · Sep 2018
Groin Controversies: Update Course 2016
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At the 4th Annual Stay Current in Pediatric Surgery Update Course in 2016, Dr. Todd Ponsky presents various cases involving groin hernia repairs. Topics discussed include reducible inguinal hernia, high ligation repair, mesh repair, hernia
video28:58 · Sep 2018
Groin Controversies - Todd Ponsky: Update Course 2014
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Dr. Todd Ponsky presents various cases involving groin hernia repairs. Topics discussed include reducible inguinal hernia, high ligation repair, mesh repair, hernia diagnostic exam, indirect versus direct hernia, open hernia repair, intraco
video28:58 · Nov 2018
2026 Laparoscopic Pediatric Hernia Repair
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Dr. Todd Ponsky from Cincinnati Children's Hospital leads an interactive course discussing controversies and various techniques for inguinal hernia repair, particularly focusing on the laparoscopic approach. He presents patient scenarios an
video123:40 · Jun 2026
Evidence & Research
1 item
Case-Based Journal Review: Inguinal Hernia 2025
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Dr. José Campos is back, this time helping us review some of the latest literature on the management of Inguinal Hernia in children. In this podcast, we're reviewing a hernia case with Dr. Todd Ponsky and incorporating literature from the l
podcast19:13 · Apr 2025
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Laparoscopic Pediatric Hernia Repair: Online Course 2017
Contralateral patent processus vaginalis presents in 30-40% of children with unilateral hernia (Holcomb 1994), with 4× greater risk of developing symptomatic hernia and 3-11% metachronous hernia rate.
host_summaryTodd Ponsky11:05 ↗
In a rabbit model, grabbing the vas deferens once with pickups obliterates it.
clinicalTodd Ponsky17:03 ↗
Zendejas 50-year follow-up (Journal of American College of Surgeons) found 5% infertility rate after hernia repair, matching general population—no evidence of infertility problem from hernia surgery.
host_summaryTodd Ponsky18:00 ↗
Andrologia study of 8500 fertility clinic patients showed markedly reduced semen quality and morphology problems in men with prior hernia repair compared to fertile controls.
host_summaryTodd Ponsky18:23 ↗
The most common cause of recurrence after open pediatric hernia repair is development of a direct hernia, not indirect recurrence.
clinicalTodd Ponsky24:51 ↗
Direct hernias after initial indirect repair may be iatrogenic: pulling up the cord during open dissection in premature infants with see-through thin floors may take fibers of the floor and cause a direct defect.
opinionTodd Ponsky25:35 ↗
Adult general surgeons performing Lichtenstein mesh repairs argue that pulling up the cord disrupts the floor even in indirect hernias, so they always reinforce with mesh or fascia repair.
host_summaryJeff Gander25:55 ↗
Current large studies from multiple countries (mostly China) report laparoscopic pediatric hernia recurrence rates of approximately 1% or less.
host_summaryTodd Ponsky27:39 ↗
Early laparoscopic hernia repairs using Z-stitch technique (Felix Shear era) had 6% or higher recurrence rates; modern techniques with modifications have reduced this substantially.
host_summaryTodd Ponsky27:28 ↗
Postoperative hydrocele after laparoscopic hernia repair is extremely rare; in 10+ years Ponsky has never required intervention for one.
clinicalTodd Ponsky67:18 ↗
In rabbit hernia model, suture ligation alone without peritoneal injury resulted in 75% failure at 2 weeks and 83% failure at 4 weeks when suture was removed.
clinicalTodd Ponsky44:16 ↗
In rabbit model, anterior peritoneal injury plus suture resulted in 87% closure at 2 weeks and 100% reperitonealisation at 4 weeks even after suture removal.
clinicalTodd Ponsky44:33 ↗
Braided non-absorbable suture (Ethibond) performed best in rabbit hernia repair studies compared to absorbable (Vicryl) or monofilament non-absorbable (Prolene).
clinicalTodd Ponsky44:58 ↗
Repeat study comparing absorbable vs. non-absorbable suture with peritoneal injury showed equal failure rates on both sides, suggesting technical error rather than suture type determined outcome.
clinicalTodd Ponsky45:49 ↗
Patent processus vaginalis may close spontaneously even years after initial identification; one case showed complete closure 3 years after documented patent processus on prior laparoscopy.
host_summaryTodd Ponsky10:18 ↗
Direct inguinal hernias begin appearing around age 29 in adults, suggesting a floor pathophysiology change at that age that may distinguish pediatric-type indirect hernias from adult-type requiring floor reinforcement.
opinionTodd Ponsky83:38 ↗
Two-center retrospective study (Kansas City and Rainbow) of adolescents receiving open high ligation showed 1.9% recurrence rate.
epidemiologicalTodd Ponsky85:45 ↗
NIH study reported 30% chronic groin pain rate after adult mesh hernia repairs, though expert hernia surgeons argue their rates are lower.
host_summaryTodd Ponsky80:28 ↗
Felix Shear ultrasound study showed no deficiency in testicular blood flow after laparoscopic hernia repair in infants.
host_summaryTodd Ponsky93:39 ↗
When performing laparoscopic hernia repair, if cord structures are visible between peritoneum and needle, the needle has passed under the cord—safe passage shows only peritoneum over the needle.
clinicalTodd Ponsky38:14 ↗
In babies, single knot ligation is preferred over double ligation to reduce suture granuloma risk from thin subcutaneous tissue; older children tolerate double ligation without granuloma formation.
clinicalTodd Ponsky52:04 ↗
With laparoscopic approach, waiting 24-48 hours after reducing an incarcerated hernia may be unnecessary since inflammation does not complicate the laparoscopic repair as it does open surgery.
opinionTodd Ponsky22:28 ↗
The 'ocean argument': laparoscopic hernia repair difficulty remains constant regardless of external complexity (incarceration, prematurity, inflammation), unlike open repair where external factors significantly increase difficulty.
opinionTodd Ponsky19:20 ↗
Munther Haddad (Leeds, UK) published series on open hernia repair with sac division but no ligation, achieving same recurrence rate as traditional ligation; argues ligation creates a smaller hernia sac rather than eliminating it.
host_summaryTodd Ponsky42:14 ↗
Mario Raquelme performs complete laparoscopic sac excision without suture closure, relying on muscle layer apposition after sac removal; reports minimal recurrences.
host_summaryTodd Ponsky49:56 ↗
Bernia technique (Godoy/Varela/Guelfand, Chile): in girls, grasp and invert the patent processus sac, then cauterize extensively to obliterate it without suture; two-center study (with Navotny) reported no recurrences.
host_summaryTodd Ponsky40:00 ↗
SEAL technique (Harrison/Albanese/Novahara, Stanford) uses large CT needle to capture substantial tissue in single pass; very fast (<1 minute) but Ponsky found high postoperative pain, possibly from capturing nerves or excessive tissue.
clinicalTodd Ponsky34:20 ↗
Survey of pediatric vs. adult surgeons on same adolescent hernia case: 86% of pediatric surgeons chose high ligation, while adult surgeons predominantly chose muscle/mesh repair—same anatomy, different training.
epidemiologicalTodd Ponsky80:55 ↗
At IPEG Hawaii ~10 years ago, ~90% of audience favored open hernia repair; at BAPS London recently, ~70-80% favored laparoscopic—represents major practice shift.
epidemiologicalTodd Ponsky91:48 ↗
Choi (Seoul, Korea) published comparison of totally laparoscopic hydrocelectomy vs. scrotal incision for pediatric cord hydrocele, demonstrating feasibility of laparoscopic approach.
host_summaryTodd Ponsky72:41 ↗
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