A 3-month-old male infant is brought with a right inguinal swelling that appears during crying and reduces when he is relaxed. The swelling is above and medial to the pubic tubercle and reduces with pressure over the deep ring. What is the definitive management?

• A Lichtenstein tension-free mesh repair
• B Herniotomy with high ligation of the sac ✓
• C Shouldice repair with posterior wall reconstruction
• D Observation with truss application until age 2 years

Explanation

Pediatric indirect inguinal hernia results from a patent processus vaginalis. The definitive treatment is herniotomy (high ligation of the hernia sac at the deep ring). Mesh repair is never used in children due to the growing abdominal wall. Observation is not appropriate as incarceration risk is high in infants. The contralateral side should also be explored or assessed laparoscopically in many centers.

Reference: Ashcraft's Pediatric Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.