PEDS

Question 1

SLIDING HERNIA REPAIR:

pediatric sliding hernia

Answer 1

Consent:
possible injury to the bowel, bladder. Injury to the ovary, tubes

1. Once the sac is identified look at the sac which may be constituted by a portion of a viscus
   or its mesentry.
   PARAesophageal attorney
2. Involved organs: the bladder medially; the cecum or its mesentery on the R side laterally and the sigmoid colon on the L side; the fallopian tubes and ovary and uterus in young girls with sliding hernias.
3. The hernia sac may seem too thick on the medial or lateral quadrants and the contained viscus may not reduce easily into the abdominal cavity
4. The sac should be opened in the normal appearing portion and the walls inspected for a sliding component.
5. Sliding hernia of intestine and bladder: the extranous normal sac is excised on either side of the sliding viscus back to the internal ring. Care is taken not to injure the viscus or its blood supply.
6. The visceral sac wall is reduced into the peritoneal cavity, much as closing a trap door
7. The neck of the sac is closed snugly with a purse-string suture, using the seromuscular portion of the inverted viscus. Additional imbricating sutures may be necessary to snug
   up the peritoneum firmly.
8. The internal ring may require tightening by fascial repair
9. In adults a mesh plug may be inserted in the internal ring to close the defect.
10. The hernia is then repaired in the usual fashion
    REF: ZUIDEMA