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Introduction: Ultrasound guided caudal epidural block (CEB) and transversus abdominis plane block (TAPB) are two techniques which are used for pain management after inguinal hernia surgeries (IHR). CEB is accepted as gold standard for lower abdominal surgeries while TAPB is more popular., Objective: It is aimed to compare ultrasound guided CEB and TAPB for postoperative pain scores, additional analgesic requirement and chronic pain development in pediatric bilateral open IHR., Study Design: Seventy patients aged 1-7 years undergoing bilateral open IHR were included in this prospective, randomized, double-blinded study. Patients were randomized into group T (Bilateral TAPB) and group C (CEB). Postoperative FLACC (Face, Legs, Activity, Cry, Consolability) scores were evaluated for pain density. Additional analgesic requirement, length of hospital stay was also recorded. Chronic pain is evaluated within a subgroup by using "revised Bieri faces pain scale" in the postoperative second month., Results: Postoperative 15th, 30th, 45th min, first, second hour FLACC scores were similar in both groups (P > 0.05). In group C, FLACC scores at postoperative sixth and 24th were significantly higher than group T (1 (0-5) vs 0 (0-2); 1 (0-3) vs 0 (0-2), respectively; P < 0.001). Additional analgesic requirement in the postoperative 24 h was found to be statistically higher in Group C (56.7%) than in Group T (20%) (P < 0.01). Chronic pain development did not differ between the groups (P > 0.05). Length of hospital stay was found to be shorter in patients in Group T compared to patients in Group C [10 (5-14) vs 16 (5-18) hours, respectively; P < 0.01)]., Discussion: Our results exhibited that TAPB and CEB for bilateral IHR have similar early analgesic efficacy in children. However; CEB patients experienced higher FLACC scores at the postoperative sixth and 24th hours, and the need for additional analgesics was higher and the length of hospital stay was longer comparing to TAPB. Of note, chronic pain was not observed in any of our subgroup patients (n = 21) who are older than four years., Conclusion: For bilateral IHR, US-guided CEB and TAPB have similar analgesic efficacy in the first six hours, postoperatively, However, TAPB appears to be slightly superior than CEB in terms of subacute pain and length of stay which is still not clinically distinctive., Competing Interests: Conflicts of interest None., (Copyright © 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: We sought to retrospectively assess the operative findings and clinical outcomes of 148 girls who underwent laparoscopic inguinal hernia repair with the percutaneous internal ring suturing (PIRS) technique., Methods: Between 2010 and 2014, girls with inguinal hernia underwent surgery using the laparoscopic PIRS technique described by Patkowski. Demographic and perioperative findings, complications, and recurrences were evaluated., Results: A total of 205 inguinal hernia repairs were performed in 148 children with a mean age of 5.83 years (1 month-16 years). In 57 girls (38.5 %), the hernias were bilaterally repaired, while in 91 girls (61.5 %) hernias were unilaterally repaired. The mean follow-up time was 3.6 years (range 2.5-6.1 years). No serious complications or recurrence were noted. Granuloma occurred in one patient., Conclusion: The PIRS technique is a safe, simple and effective procedure for girls. Excellent cosmetic results and reduced recurrence rates are associated with this method. This procedure is particularly suitable for girls because they lack a spermatic cord and vascular structures that can cause complications with this technique in boys. Based on our experience and others in the literature, we suggest that the PIRS procedure might be considered a gold standard for inguinal hernia operations in girls.

Crossed testicular ectopia or transverse testicular ectopia is an extremely rare anomaly characterised by migration of one testis towards the opposite inguinal canal, usually associated with unilateral inguinal hernia. This report describes six cases of crossed ectopic testes, one of the largest series, and with unusual clinical histories.

Purpose: We aimed to compare laparoscopic hernia repair and open hernia repair in recurrent cases after first open repair according to the length of time taken to perform the procedure., Methods: Between November 2009 and December 2011, the medical records of 26 male paediatric patients who were treated with laparoscopic surgery (with Schier's intracorporal "N" suture closure) and open surgery (with high ligation technique) in our institution for recurrent inguinal hernia were reviewed for the length of the operative time and post-operative complications retrospectively. Thirteen cases operated with laparoscopic repair were regarded as Group 1 and other 13 cases operated with the open high ligation repair were regarded as Group 2. All recurrent hernia cases had been performed in other hospitals with the open high ligation technique previously., Results: Thirteen internal inguinal ring closures in Group 1 were performed laparoscopically. In Group 2, 13 cases underwent open high ligation repair. Comparing the laparoscopic and open-repair techniques in the recurrent cases (Group 1 vs. Group 2; 32.36 vs. 61.07 min, respectively) showed that the length of the operation time was much shorter in laparoscopic repair group (Group 1) than open repair group (Group 2). A statistically significant difference was also observed (p = 0.001). No post-operative testicular atrophy or recurrence was seen until present time in all groups., Conclusion: We propose that laparoscopic repair in recurrent childhood inguinal hernia cases, developed after open repair, avoids entering a fibrotic inguinal canal, making the procedure easier and shorter. Laparoscopic herniorrhaphy is a good alternative option in recurrent childhood hernia.