title: Open inguinal herniotomy: Analysis of variations.
abstract: BACKGROUND
  Repair of congenital groin hernia/hydrocele is the most common surgical procedure performed by paediatric surgeons. There is dearth of literature comparing the outcomes of open herniotomy in children using various surgical approaches. This study was aimed at evaluating the efficacy of open herniotomy by comparing external ring incision, hernial sac twisting and whether or not double ligation has benefit over a single suture application.
  
  
  METHODS
  A multi-centre prospective randomised clinical trial was conducted with a total of 428 patients having congenital inguinal hernia and/or hydrocele. Patients were randomly assigned into four groups: RO (had external ring opened, hernial sac twisted and doubly ligated), ST (had hernial sac twisted and doubly ligated without opening the ring), DL (had double ligation of hernial sac without ring opening nor twisted) while SL (had single ligation of hernial sac with neither ring opening nor sac twisting).
  
  
  RESULTS
  A total of 458 repairs were done. Patients' age ranged from 0.25 years (3 months) to 21 years in group RO with mean of 4.87 × 4.07 (median, 4), 0.069 years (24 days) to 17 years in group ST with mean of 4.23 × 4.03 (median, 3), 0.5 years (6 months) to 16 years in group DL with mean of 4.59 × 3.87 (median, 4) and 1 year to 19 years in group SL with mean of 5.00 × 4.19 (median, 4). Operation time per repair was 26.50 × 5.46 min, range 16-40 min (median, 27 min) in group RO, 22.18 × 5.34 min, range 12-39 min (median, 21 min) in group ST while 17.98 × 3.40 min with range of 12-39 min (median, 17 min) in group DL and 15.27 × 4.18 min, range 7-40 min (median, 15 min) in group SL P < 0.0001. The mean paracetamol dose/patient was 3.96 × 1.43, 2.94 × 0.81, 2.18 × 0.69, 1.87 × 0.78 in group RO, ST, DL and SL, respectively, P < 0.0001.
  
  
  CONCLUSIONS
  Congenital inguinal hernia repair with opening of the external ring, hernia sac twisting and double ligation of the processus vaginalis confers no advantage.
authors.affiliation: Department of Surgery, Children Surgical Unit, Murtala Muhammad Specialist Hospital, Kano, Nigeria.
authors.forename: Musa
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Mu'azu Adamu
authors.initials: MA
authors.lastname: Ladan
authors.forename: Umar Sharif
authors.initials: US
authors.lastname: Abdussalam
authors.forename: Kabiru Ibrahim
authors.initials: KI
authors.lastname: Getso
authors.forename: Mohammad Aminu
authors.initials: MA
authors.lastname: Mohammad
authors.forename: Anyanwu Lofty-John
authors.initials: AL
authors.lastname: Chukwuemeka
authors.forename: Femi Luqman
authors.initials: FL
authors.lastname: Owolabi
authors.forename: Nurlan Nurkenovich
authors.initials: NN
authors.lastname: Akhparov
authors.forename: Rassulbek Rakhmanberdievich
authors.initials: RR
authors.lastname: Aipov
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006552:Hernia, Inguinal / Q000151:congenital / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D006848:Testicular Hydrocele / Q000151:congenital / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult