A new, simple operative approach for

bilateral inguinal hernia repair in girls: A

single transverse supra-pubic incision

Introduction
Males are more likely to have hernia
with 3:1 10:1 ratio
6% females present with bilateral
inguinal hernia

Materials and Methods

The new approach was performed on
99 female children 12 years old
with bilateral inguinal hernias at a
single institution at the European
Gaza Hospital, Gaza, Palestinian
Territories between January 2005 and
April 2012

Technique
Patient in supine position, general anaesthesia, a 11.5 cm midline transverse suprapubic skin incision
is made along the skin crease
Incision is carried down through the dermis to
expose the subcutaneous fat, Camper's fascia.
Using sharp and blunt dissection, Scarpa's fascia is
identified, grasped and incised in the direction of
the targeted hernia (right or left). Gentle retraction
is needed laterally to maintain excellent exposure.
The sac is exposed and elevated off the inguinal
floor
From this point onwards, the steps of standard
hernia repair with a high ligation are followed
according to the surgeons technique.
The external inguinal ring was not opened in any of
the patients. After finishing the repair of one side,

Results
Median age was 2 years (range: 1
month-12 years)
Median operative time was 12
minutes (range 5-22)
One patient had an incarcerated, but
viable ovary
Two patients had bilateral sliding
hernias and the remainder had
indirect hernias

 Post-operatively 2 patients
developed non-expanding small
hematomas, both treated nonoperatively without sequelae or
intervention
There were zero hernia recurrence
and on follow-up was achieved in
99% of patients
Median follow up was 5 years (range:
1-8 years)

Discussion
This technique is performed on girls
and not boys because the technical
repair in girls is much easier than
male inguinal hernia repair where the
vas deferens and testicular vessels
need to be spared, whereas there is
no need to save the round ligament
in girls
Probably no advantage to this
approach in older children with

 As children grow, the internal ring

becomes more lateral in position
compared to the external ring. This
anatomic relationship should be
considered when repairing the hernia
in older children
There is a selection bias, as this was
a retrospective study that selected
excellent candidates

 deally, the next step is to perform a

randomized controlled study
comparing our approach to the
standard bilateral incision to
determine any differences

Conclusion
We describe a new, safe, simple, and
rapid approach for bilateral inguinal
hernia in female pediatric population.
A midline suprapubic transverse skin
incision was adequate for exposing
both inguinal regions with excellent
postoperative results. Median patient
follow-up of 5 years was excellent
and reliable