Inguinal herniotomy in a female child. Does one transfix the round ligament while tacking the sac?
Be aware: inguinal hernia's in females might occur in XY females (tetosteron receptor insensitivity syndrome)
Point noted Peiter. that is the reason I would a Genitoscopy in females with inguinal hernia more so if bilateral and definite work up if there is likely to be a palpable gonad (esp if irreducible).
My question is how do you tackle the round ligament while doing inguinal herniotomy in a female child? Does one transfix round ligament at all times? or does one painstakingly dissect sac from same? If transfixed then in the long term does it lead to any problems considering round ligaments are false supports of the uterus (Would transfixing and cutting same it lead to increased incidence of Prolapse uterus later in life?)
- Try to avoid the round ligament, isolate the hernial sac and divide it separetely.
I have no experience with transfixing the round ligament.
- Laparoscopy is indicated in bilateral cases to manage the hernias and to have a look on the gonads and uterus and to rule out other syndromes.
- Chromosomal analysis in suspected cases.
- DSD may present with bilateral hernias.
Dear Dr Naji - Would you do laparoscopy in unilateral hernia in a female child with no palpable irreducible gonad?
Bilateral if occurs on left hand side.
Low risk, easy procedure and avoid annoying metachronous occurrences.
Kind regards
Why only left? Even if the incidence of metachronous recurrence is lower, the procedure is essentially same and very safe as well. Question is do you do chromosomal analysis in every female hernia?
- Laparoscopy in Bilateral hernia in a female as I mentioned above. If I do laparoscopy then no need for chromosomal analysis.
- Chromosomal analysis is indicated in bilateral cases if you intend to operate them with open technique. Most of the cases (if not all) of females 46 XY DSD develops hernia. Some authors recommend chromosomal analys even in unilateral hernia when you palpate a gonad in it. We do not do it as a routine.
If one were to palpate an Irreducible Gonad repeat irreducible- its unlikely to be ovary.
So definitely in irreducible gonad Chromosomal analysis foll by laparoscopy and herniotomy.
Androgen insensitivity syndrome (Testicular feminization syndrome) should be suspected
It is better bilateral because the other side will become evident soon.
both side by a supra pubic incision(2 to 3 cm, depending on the age) tranversal in the cutaneous line. After the dissection of the median pre aponeursis fat, rather easy acces to both inguinal rings. Ans yes, I still transfix the round ligament, even if I really have no idea of the usefulness of It.
Depends on age in FEMALE if less than 2year and hernia manifestation on left side bilateral herniotomy can be performed.
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