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THE MANAGEMENT OF INFANTS UNDER 3MONTHS OF AGE WITH CONCOMITANT
INDIRECT INGUINAL HERNIA AND IPSILATERAL PALPABLE UNDESCENDED TESTIS
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Naomi Wright , Joseph Davidson , Christina Major , Nigel Hall , Nordeen Bouhadiba
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Evelina Children´s Hospital, London, UK, University Hospital Lewisham, London, UK,
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Faculty of Medicine, University of Southampton, Southampton, UK
Background: There is scarce literature and no current guidelines regarding the management
of boys under 3 months with concomitant indirect inguinal hernia (IIH) and ipsilateral palpable
undescended testis (IPUDT). These pathologies coincide in approximately 1% of inguinal
hernias in children.
Aim: To undertake a national UK survey to define surgeons’ current practice in this patient
population.
Methods: A 10-question survey was administered to all UK based surgeons on the British
Association of Paediatric Surgeons register (N=100).
Results: Seventy-four consultants responded: 62 paediatric surgeons, 12
paediatric urologists. Of these, 82% (n=61) routinely perform open herniotomy in this
population whereas 18% (n=13) perform laparoscopic hernia repair. In the absence of clinical
evidence of IIH, 4% (n=3) undertake orchidopexy for UDT at 3-6months, 62% (n=46) at 612months and 34% (n=25) >12 months of age.
In boys <3 months with both reducible IIH and IPUDT, 54% (n=40) would proceed to
herniotomy and orchidopexy at this age, 23% (n=17) would undertake herniotomy at present
and delay orchidopexy until >3 months of age and 8% (n=6) would delay both
until >3months. Fifteen percent (n=11) would vary management depending on clinical and
operative findings.
Of those who would proceed with IIH repair <3 months, choice of operative procedure varied
widely (Figure 1). The most common was open herniotomy and standard orchidopexy (45%,
N=30). If the hernia was difficult to reduce, fewer surgeons would undertake concurrent
orchidopexy (37%, n=25) and even less in the presence of an obstructed hernia (24%, n=16).
The proportion undertaking laparoscopic hernia repair and future orchidopexy was similar in
all 3 scenarios, 15-18%.
Conclusion: There is a wide variety of practice across the country in managing this patient
population, which reflects the lack of evidence supporting best practice. Multicentre
prospective data are required to determine the optimum treatment pathway.