The laparoscopic spectrum of inguinal hernias and their recurrences

In a retrospective study, intraoperative photos and video documentations of 884 children demonstrate that inguinal hernias and their recurrences are aspects of a full spectrum, which ranges from fully closed internal inguinal rings (IIR) and small openings to all-the way-down-into-the-scrotum open processus; 92% of the children had indirect and 2% direct hernias, 4% had no open IIR, 1% was femoral, 2% were hernias en pantalon and 1% combinations of indirect, direct and femoral hernias; 3% were recurrences. Among the 28 children with recurrences, the IIR was fully open in only 36%, partially open in 25%, had only a small opening in 21% and even a closed IIR in 18%. The present paper demonstrates that the yes/no concept of inguinal hernia needs to be redefined. Hernias and their recurrences constitute a spectrum. There are hernias and recurrences without a laparoscopically visible open IIR.