title: Late abscess formation following indirect hernia repair utilizing silk suture.
abstract: Inguinal hernia repair is the most common operation performed by pediatric surgeons. The critical portion of the operation is high ligation of the hernia sac, which is classically performed with silk suture. This foreign body has the potential to serve as a nidus for latent infection/rejection that may result in an abscess long after the operation. This complication has rarely been described in the literature. We have cared for six children who have presented with latent inguinal or pelvic abscesses following high ligation of the inguinal hernia sac with silk suture. The purpose of this report is to examine the varied presentations by which latent complications following herniorraphy may manifest. The pediatric surgeon should recognize that not every inguinal mass following a previous inguinal herniorraphy represents a recurrent hernia! A retrospective review of the charts of six patients with late abscess formation following antecedent inguinal hernia repair was undertaken. The details of the initial and operative endeavors were recorded with specific attention to the details of the initial operative hernia repair as well as the suture material utilized. Inguinal hernia repair continues to be the most common operation performed by pediatric surgeons. Utilization of braided, non-absorbable silk suture may result in latent abscess formation and the need for operative drainage of inguinal or pelvic abscess. Today, as other types of suture material are likely equally efficacious in the ability to effectively close the patent processus vaginalis, pediatric surgeons should consider utilizing non-braided, or absorbable suture material for high ligation of the indirect hernia sac to potentially prevent this complication.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Wisconsin, Milwaukee, WI 53045, USA. ccalkins@chw.org
authors.forename: Casey M
authors.initials: CM
authors.lastname: Calkins
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Anthony
authors.initials: A
authors.lastname: Balcom
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Murphy
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002675:Child, Preschool; D015653:Cystectomy / Q000379:methods; D004322:Drainage; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016908:Gram-Positive Bacterial Infections / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D010388:Pelvis; D010462:Peptostreptococcus / Q000302:isolation & purification; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D047011:Silk / Q000009:adverse effects*; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors
chemical_list: D047011:Silk