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  • 1. Right Incision
  • 2. Dissection
  • 3. Right Closure
  • 4. Left Incision
  • 5. Dissection
  • 6. Left Closure
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Pediatric Infant Bilateral Open Inguinal Hernia Repair - Twin A


Domingo Alvear, MD1; Lissa Henson, MD2; Jaymie Ang Henry, MD, MPH3

1World Surgical Foundation
2Philippine Society of Pediatric Surgeons
3Florida Atlantic University, G4 Alliance

Main Text


An inguinal hernia is a protrusion of intra-abdominal contents through the inguinal canal that can arise at any time from infancy to adulthood. It is more common in males with a lifetime risk of 27% as compared with 3% in females. The majority of pediatric inguinal hernias is congenital and is caused by failure of the peritoneum to close, resulting in a patent processus vaginalis. Inguinal hernias present as a bulge in the groin area that can become more prominent when crying, coughing, straining, or standing up, and disappears when lying down. Diagnosis is based on a thorough medical history and physical examination, but imaging tests such as ultrasound can be used when the diagnosis isn't readily apparent. Inguinal hernias are generally classified as indirect, direct, and femoral based on the site of herniation relative to surrounding structures. Indirect hernias protrude lateral to the inferior epigastric vessels, through the deep inguinal ring. Direct hernias protrude medial to the inferior epigastric vessels, within Hesselbach’s triangle. Femoral hernias protrude through the small and inflexible femoral ring. In infants and children, inguinal hernias are always operated on to prevent incarceration. Surgical correction in infants and children is done by high ligation of the hernia sac only, called a herniotomy. Here, we present a female infant with bilateral inguinal hernias. Upon exploration, a hernia sac was found, and ligation was performed bilaterally.

The bilateral inguinal hernia repair on the other twin can be seen at

Main text coming soon.