Individual and associated effects of length of inguinal canal and caliber of the sac on clinical outcome in children.
OBJECTIVE
The caliber of processus vaginalis is accepted to define the clinical outcome to be an inguinal hernia or hydrocele not based on any evaluation. The caliber of sacs and length of inguinal canals of boys and girls were evaluated to define the relation of sex, age, and the diagnosis with caliber of the sac and the length of inguinal canal.


METHODS
A total of 217 inguinal canals in 24 girls and 112 boys with inguinal hernia, 30 boys with hydrocele or hydrocele of the cord, and 31 boys with undescended testis have been evaluated. Twenty patients had bilateral involvement. The length of inguinal canal, and the circumference of the sac were measured. A formula was developed to predict the length of inguinal canal according to the age and sex. The circumferences of the sacs, length of inguinal canals, and the ratios of the circumference to the length were compared according to the clinical pictures.


RESULTS
The regression model of the relationship between the age and the length of the inguinal canal is an equation of third degree (inguinal canal in millimeters) = 0.0000119 x age 3 (months) - 0.00292 x age 2 (months) + 0.3168 x age (months) + 19.979 (r2 = 0.47). Inguinal canal is longer in boys (25.133 and 27.996 mm; P = .018), and length does not differ among diagnoses but differs according to age showing a linear growth after 24 months. Although the circumference as a sole parameter could classify only 55.3% of boys correctly, the ratio of length of inguinal canal to circumference of the sac has been the significant parameter in classifying boys into 1 of 3 groups including inguinal hernia, undescended testis, and hydrocele with a 70.2% success rate.


CONCLUSIONS
Inguinal canal that shows a linear growth after 24 months of age is longer in boys. Caliber is not the unique factor that determines the clinical outcome. Although the ratio of length of inguinal canal to the circumference of the sac defines the clinical picture best, even this parameter cannot classify the cases correctly. Therefore, some factors in addition to the caliber and length of inguinal canal might have roles in determining the clinical outcome.
Tanyel
F C
FC
Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Ocal
T
T
Karaağaoğlu
E
E
Büyükpamukçu
N
N
D000367:Age Factors; D002675:Child, Preschool; D003456:Cryptorchidism / Q000473:pathology / Q000601:surgery; D005260:Female; D006552:Hernia, Inguinal / Q000151:congenital* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000254:growth & development / Q000473:pathology*; D008297:Male; D012737:Sex Factors; D006848:Testicular Hydrocele / Q000151:congenital* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome