A 2-year-old boy has a reducible right inguinal hernia. There is no history of incarceration. What is the standard definitive management?

• A Laparoscopic TEP repair with preperitoneal mesh
• B Lichtenstein tension-free mesh repair
• C Shouldice multilayered tissue repair
• D Open herniotomy with high ligation of the patent processus vaginalis, without mesh ✓

Explanation

Paediatric inguinal hernias result from a persistent processus vaginalis rather than from weakness of the canal floor, so simple high ligation of the sac (herniotomy) is curative and mesh is unnecessary and undesirable in a growing child. Mesh repairs such as Lichtenstein, Shouldice and TEP address myopectineal or floor weakness, a problem that does not exist here. In children under about one year, or when the opposite side is symptomatic, laparoscopic inspection of the contralateral ring may be added, but the index-side operation remains herniotomy.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.