Inguinal Hernia Containing the Uterus in the Pediatric Patient: A Systematic Review

Abstract

Background

Inguinal hernia containing the uterus in pediatric patients with normal karyotype and phenotype is an extremely rare entity, and no consensus is available concerning diagnosis, surgical management, and follow-up.

Methods

A systematic review according to the Synthesis Without Meta-analysis protocol was conducted. Studies including pediatric female patients with inguinal hernia containing the uterus were searched. Keywords and mesh term searches were conducted (Medline, Scopus, and Web of Science). We additionally reviewed our center's clinical records and found 1 patient with an inguinal uterus hernia that was included in the statistical analysis.

Results

Thirty-six articles and 73 patients were considered for this analysis. The median gestational age at birth was 36 weeks. The inguinal mass was first noticed at the median age of 1.5 months (0-18 months), on the left side in 61% (on the right in 16, 39%). Sixty percent of patients had no associated symptoms or signs; 37.5% showed symptoms and signs of an incarcerated hernia. Median age at surgery was 2 months (1-72 months). In all patients, one or both adnexa herniated with the uterus. An open approach was more frequently used (56.4%). Contralateral duct exploration and ligation was performed in 7 patients (24.1%). No postoperative complications or recurrence have been described.

Conclusions

The data obtained do not allow us to draw univocal conclusions on which is the best management in these patients. It is still unclear if an elective approach in an asymptomatic patient might bear long-term consequences on reproductive functions. No surgical technique proved to be superior to others, but both the open and laparoscopic approaches seem to be effective without postoperative complications or recurrence.

Introduction

Indirect inguinal hernia, caused by the patency of the processus vaginalis, is one of the most common congenital anomalies in children, and its repair is among the most frequent procedures in pediatric surgery. Its overall incidence reported in literature ranges from 0.8% to 4.4%, reaching 30% in premature infants, and boys are affected as much as 6 times more frequently than girls.¹ In girls, the ovary and fallopian tube can herniate in up to 20% of cases,² and they can frequently become incarcerated. Herniation of the uterus in phenotypically and genotypically normal girls has always been considered an extremely rare condition, and the literature lacks extensive studies. Despite several case reports having been published since 1900,3., 4., 5., 6., 7., 8. there is a lack of consensus concerning the diagnostics, surgical timing and approach, necessity of contralateral exploration, and specific follow-up. To address these issues, we performed a systematic review of the literature, with special attention to the management with regard to patients’ outcomes, namely hernia recurrence, postoperative complications, and long-term gynecological function, with the aim to assess whether any clinical or treatment features might have an impact on patients’ outcomes.