Definition
Ligation of the patent processus vaginalis, through which intraabdominal viscera have passed into the inguinal canal.
Discussion
- Most pediatric inguinal hernias are indirect, therefore correction is accomplished by a high ligation of the patent processus vaginalis (sac) without repair of the inguinal floor.
- In the male patient , care must be taken to avoid injury to the spermatic cord structures. A hydrocele (undescended testicle) may be associated with the hernia, and is usually corrected at the same time.
- In the female patient, the ovary and fallopian tubes may be encountered within the hernial sac. Routinely, both groin areas will be explored, since it is not unusual for small children to have bilateral hernias owing to the close proximity of the involved anatomic structures.
Positioning
- Supine, with arms restrained at the side.
Packs/Drapes
- Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.
Instrumentation
- Pediatric laparotomy tray
Supplies/ Equipment
- Thermal blanket and / or heating lamp
- Head covering
- Extremity wrap or thermal sheet
- Handheld cautery or bipolar cautery
- Suction
- Basin set
- Blades
- Needle counter
- Dissector sponges
- Solutions
- Sutures
Procedure Overview
- A transverse incision is made over the inguinal area in the direction of the skin crease, exposing the external oblique aponeurosis (a fibrous sheet of connective tissue), which is then incised.
- The contents of the inguinal canal are explored, and the sac is identified.
- If a hydrocele is present, the sac is ligated and the excess sac is removed.
- The external oblique aponeurosis is closed; the skin is closed using a subcuticular technique.
- If a sliding hernia (in females) is present (e.g. part of the sac wall is the broad ligament of mesentery), the sac is transected and ligated as close as possible to the sliding portion, including the round ligament.
- The transversalis fascia is closed over the defect prior to closure of the external oblique aponeurosis.
- A subcutaneous closure with Steri Strips or collodian dressing is performed.
Perioperative Nursing Procedures
- To avoid hypothermia, do not start the skin preparation until the surgeon is in the room and ready to begin.
- Use warm preparation solutions, exposing only the immediate area involved with the incision site.
