Absorbable sutures vicryl 1 continuous double layer repair will be enough

Im on this technique > 15 years with good results

Is it preferable to operate in neonatal period or should wait if its not complicated

Mrs. Nabiha

The authors mostly depend on the child weight if it was 2-5 kg there will be no problem to operate at the neonatal period.

Congenital hernia may be anywhere (Inguinal / diaphragmatic / umbilical / spigelian etc).

1. Sutures used and why (long duration absorbable or non-absorbable sutures)?

Always absorbable sutures are used. Typically Vicryl / PDS 4/0 5/0 are used

2. Continuous or interrupted sutures and why?

Neonatal / pediatric herniotomy is different from the adult hernia repair, as posterior wall weakness (highlight of adult hernia) is usually not a feature in children (exceptionally it may present in connective tissue / storage disorders)

3. Simple or double breasting sutures and why?

Herniotomy and not hernioplasty is done. Hence only sac ligation is carried out without the posterior wall strengthening sutures.

4. Other additional thoracic/abdominal procedures performed/required?

Congenital diaphragmatic hernia / eventration may require abdominal / thoracic procedures

5. All above based on evidences/following the seniors/learned by self experience?

As per standard protocols / guidelines

6. Others comments

In general, Inguinal hernias are the most commonly detected hernia in the neonatal period. Inguinal hernia in a preterm child has a higher risk for incarceration than that in a term child, hence early repair is advocated.

Your questions

1. Sutures used and why (long duration absorbable or non-absorbable sutures)?

2. Continuous or interrupted sutures and why?

3. Simple or double breasting sutures and why?

4. Other additional thoracic/abdominal procedures performed/required?

5. All above based on evidences/following the seniors/learned by self experience?

6. Others comments are also welcome.

My anwers

1. I actually prefer non-absorbable sutures for CDH closure because of less risk of recurrence. Silk, braided polyester or even monofilament polypropylene work well.

2. Traditionally I did interrupted sutures but I now use continuous suturing because it is quicker. Some of these babies are tenuous and should not be under anesthesia for a prolonged time.

3. If I have a good shelf to sew to, one layer of sutures is enough. If not, there are a few helpful techniques. Our fellow Yoon Jung Boo published a neat technique a few years ago Article A Novel Technique of Posterolateral Suturing in Thoracoscopi...

4. I usually approach the CDH from the abdominal side when I do an open repair, from the chest if I do it thoracoscopic. If there is a sack, there is another neat technique that you can use, published by our fellow Takafumi Kawano

Article A new gentle reduction technique for patients with congenita...

5. All of the above based on a lot of interaction with many colleagues and 2 decades of personal experience

6. CDH is a huge topic, so need to focus on specific questions.