title: Irreducible inguinal hernia in children: how serious is it?
abstract: OBJECTIVE
  We evaluated the experience with irreducible inguinal hernias at our institution.
  
  
  METHODS
  We reviewed patients with an inguinal hernia operation at our institution between 1st January 2004 and 31st December 2013. Individuals with a failed manual reduction of an incarcerated hernia under sedation by the attending surgeon were included into the study group as irreducible hernia.
  
  
  RESULTS
  Overall 2184 individuals (426 females) had an inguinal herniotomy with the following distribution: right 1116 (51.1%), left 795 (36.4%) and bilateral 273 (12.5%) cases. A laparoscopic herniotomy was done in 1882 (86.4%). 34 patients (3 females) - just 1.6% of the total - presented at a median age (corrected for gestation) of 12 months (range 2 weeks to 16 years) with an irreducible hernia, of which 24 individuals (70%) were right sided. A laparoscopic approach was attempted in 21 (62%), two required a conversion. The open technique was chosen in 13 (38%) individuals. The content of the hernia sac was distal small bowel in 21 (62%), omentum in four (12%) and an ovary in three (9%) cases. Four patients (12%) required laparoscopic assisted bowel resection and two partial omentectomy (6%). Two gonads (6%) were lost: one intraoperative necrotic ovary and one testis atrophied over time. There was no recurrent hernia.
  
  
  CONCLUSIONS
  Irreducible inguinal hernias constitute 1.6% of the workload on inguinal hernia repair. The hernia sac contains in males most frequently small bowel and in females exclusively a prolapsed ovary. Significant comorbidity is present in 18%. Laparoscopic and open techniques complement each other in addressing the issue.
authors.affiliation: Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China. Electronic address: chhouben@web.de.
authors.forename: Christoph Heinrich
authors.initials: CH
authors.lastname: Houben
authors.affiliation: Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: Kin Wai Edwin
authors.initials: KW
authors.lastname: Chan
authors.affiliation: Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: Jennifer Wai Cheung
authors.initials: JW
authors.lastname: Mou
authors.affiliation: Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: Yuk Huk
authors.initials: YH
authors.lastname: Tam
authors.affiliation: Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: Kim Hung
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001284:Atrophy / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009336:Necrosis; D009852:Omentum / Q000601:surgery; D010049:Ovarian Diseases / Q000601:surgery; D010053:Ovary / Q000473:pathology; D013737:Testis / Q000473:pathology; D016896:Treatment Outcome
keywords: Complication; Inguinal hernia; Laparoscopy