# Rare intraoperative findings during the management of pediatric inguinal pathologies: a decade of experience

## TL;DR

This paper reports on rare anatomical findings in pediatric inguinal surgeries over ten years, emphasizing their low frequency but the need for surgical awareness and training.

## Contribution

The study provides a comprehensive review of rare intraoperative findings in pediatric inguinal surgeries from a single institution over a decade.

## Key findings

- Rare intraoperative findings occurred in 0.8% of 8,756 pediatric inguinal surgeries.
- Common rare findings included Amyand's hernia, looping vas deferens, and complete androgen insensitivity syndrome.
- Preoperative imaging and laparoscopic techniques improved detection and management of these anomalies.

## Abstract

Pediatric inguinal surgeries, including procedures for inguinal hernias, undescended testes, and hydroceles, are among the most common surgical interventions in children. While these conditions are well-understood, rare intraoperative findings and anatomical variations can complicate surgical management. This study reviews a decade of experience at a single institution to evaluate the incidence, management, and outcomes of such rare findings.

A retrospective observational study was conducted at a tertiary pediatric surgery center in Egypt, analyzing all inguinal surgeries performed between 2013 and 2022. Patients aged ≤14 years with complete operative records were included. Rare findings were defined as anomalies not typically encountered in standard procedures and were independently reviewed by two surgeons. Data were extracted from surgical logs, operative notes, and electronic records.

Among 8,756 patients (85.5% male, 14.5% female), rare intraoperative findings were identified in 69 cases (0.8%). These included Amyand's hernia (n = 12), looping vas deferens (n = 34), splenogonadal fusion (n = 2), complete androgen insensitivity syndrome (CAIS, n = 7), congenital unilateral absence of the vas deferens (CUAVD, n = 5), crossed ectopic testes (n = 5), ureteroinguinal hernia (n = 1), Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome (n = 1), and encysted hydrocele (n = 1, female). Most anomalies were identified incidentally, with management tailored to preserve function and minimize complications.

Rare findings in pediatric inguinal surgery, though uncommon (<1%), necessitate surgical adaptability and awareness. Preoperative imaging and laparoscopic techniques enhance detection and management. Training programs should emphasize these anomalies to optimize outcomes.