Alternative method for repair of the difficult infant hernia

BACKGROUND: Inguinal hernia repair in the small infant is often technically difficult. An alternative operative approach has been developed that can simplify troublesome repairs, while decreasing the potential risks of damage to cord structures and of recurrence. METHODS: Thirteen small infants (weight 1400-3000 grams) underwent inguinal hernia repair using a technique of direct closure of the internal inguinal ring via a trans-hernial sac approach. Dissection of cord structures from the sac was avoided. RESULTS: All hernia repairs remained intact on follow-up of 4-28 months. One patient early in the series developed a noncommunicating hydrocele, prompting the addition of sac eversion to the original technique. CONCLUSIONS: An alternative method for simplified repair of difficult infant hernias has been used with success. While it does not supplant traditional repair technique for most patients, it should be considered for use in selected situations.