From
StayCurrentMD
Adolescent Surgery Session: They Look Like Adults, but Aren't the Same-Hernia Repair
With Dr. Joe Dodd & Dr. Harrod Patel · hosted by Dr. Todd Ponsky
Chapter 6 of 6 · Case-Based Learning
Audience discussion
Audience discussion: mesh timing, recurrence definition, and hernia classification
Cued at 12:25 · press play
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
In Europe, surgeons treat pediatric inguinal hernias by dividing the sac without ligation, and this approach works due to a shutter mechanism where the muscle closes once the peritoneum retracts.
Multi-center retrospective review of 150 adolescent patients (ages 13-18) with 2-year follow-up showed 2 recurrences among 53 responders.
Recurrence rates with mesh in adults are clearly much better than without mesh.
Mesh is known to shrink over time based on available data.
NYHUS class 1 hernias should receive just high ligation in many practices.
Ziggy Iron's study of 6000 patients showed a 1.2% recurrence rate after high ligation in babies.
Zendejas study in Journal of American College of Surgeons followed 332 patients for 50 years after pediatric hernia repair, with 213 responding to survey, showing 8.4% had groin operation on same side.
In the Zendejas 50-year follow-up study, of 12 patients who had groin operations, only 4 were indirect hernias while the rest were direct hernias, suggesting true indirect recurrence rate is 2-4%.
Mesh repairs have an 11 to 30% incidence of chronic pain according to multiple articles.
Beetz 1997 study compared high ligation to Bassini and Shouldice repairs in adults, finding Shouldice had lowest recurrence rate but Bassini and high ligation had the same recurrence rate.
In rabbits, squeezing the vas deferens once with pickups obliterates it.
The physiological basis for high ligation working in children is that the external ring and internal ring are right on top of each other, and as children grow, the internal ring separates from the external ring.
In Hong Kong, over 1000 laparoscopic high ligation patients have been treated with no reported recurrences, though the speaker expresses skepticism about this claim.