A 2-year-old boy has a reducible right inguinal hernia. Exploration shows a patent processus vaginalis with normal cord structures. What is the appropriate definitive operation in a child of this age?
- A Lichtenstein tension-free mesh repair
- B Herniotomy alone, that is, high ligation of the sac at the deep ring ✓
- C Shouldice multilayered repair
- D McVay repair with division of the inferior epigastric vessels
Correct answer: B. Herniotomy alone, that is, high ligation of the sac at the deep ring
Explanation
Paediatric inguinal hernia results from persistence of the processus vaginalis in an otherwise normal abdominal wall, so simple high ligation of the sac (herniotomy) at the level of the deep ring is curative, and recurrence rates are very low. Mesh repairs such as Lichtenstein are reserved for adults whose weakness involves the musculoaponeurotic floor, and placing prosthetic mesh in a growing child is avoided. Tissue repairs like Shouldice or McVay add nothing when the floor is structurally normal.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.