Novel insights and improvements for the diagnosis and surgical treatment of inguinal hernia in children

This thesis contributes towards novel insights and improvements for the diagnosis and surgical treatment of inguinal hernias in the paediatric population. Inguinal hernia is the most common congenital surgical disorder in children that arises if the processus vaginalis remains patent; fat, intestines or fluid can then move into the open inguinal canal and present as a clinically visible hernia. Inguinal hernia repair represents the most commonly performed surgery in children and is necessary because of the danger of strangulation of bowel, testis or ovary. Controversies exist about e.g. the optimal treatment strategy (open or laparoscopic approach) and timing of surgery in preterm children and girls with ovarian hernia. For over more than 50 years there has been an ongoing debate about whether to perform contralateral exploration or not to prevent development of a metachronous contralateral inguinal hernia (MCIH).
In part I, we evaluate the diagnostic work-up and referral pattern of children with suspected inguinal hernia and assess the clinical manifestations in girls with ovarian hernia and a prematurely born infant with chylous ascites as content of the inguinal hernia. Part II focuses on improving the current treatment strategy and preparation materials for inguinal hernia surgery by introducing an innovative one-stop-surgery program and age-specific information modalities to prepare children at home for surgery. Part III evaluates current surgical treatment techniques for inguinal hernia repair and includes the first international guideline on the surgical management of paediatric inguinal hernias. Finally, in part IV, we assess the use and effectiveness of preoperative diagnostic ultrasound and perioperative contralateral exploration to prevent development of MCIH.