WOFAPS 2025 8th World Congress of Pediatric Surgery

Arije Zouaoui, Fatma Thamri, Yasmine Karoui, Yosra Kerkeni, Riadh Jouini

Pediatric Surgery Department, Children's Hospital Bechir Hamza, Tunis, Tunisia

Introdution:
Inguinal hernia repair in children is classically performed without mesh, given their growth potential and lower recurrence rates compared to adults. However, in complex or recurrent cases, standard approaches may fail, raising the question of mesh reinforcement. We report two cases illustrating the role of Vicryl mesh in pediatric inguinal wall reconstruction.

Cases' presentation:
The first case involved a 9-year-old albino boy with bilateral inguinal hernias. Initially operated at age 5 due to painful, disabling symptoms, he experienced four early recurrences (within 2 to 4 weeks postoperatively), despite multiple high sac ligations combined with muscular and ligamentous reconstruction, all performed without mesh. Given the repeated failures, mesh reinforcement using Vicryl mesh, inspired by the Lichtenstein technique, was performed. At one-year follow-up, no recurrence was observed.
The second case concerned a child with metastatic nephroblastoma (testis and inguinal lymph nodes). During surgery for inguinal tumoral recurrence, the tumor was found extending into the peritoneal cavity and infiltrating the anterior aponeurosis of the external oblique muscle. An oncologic en-bloc resection, including the involved aponeurosis, was necessary. Abdominal wall reconstruction was achieved using a Vicryl mesh. Postoperative recovery was uneventful, with no eventration after one month, and the abdominal wall remained structurally solid.
A third patient, with hydrocephalus and a ventriculo-peritoneal shunt, presented with large bilateral inguinal hernias recurrent after standard repair. Mesh placement was planned, but the patient died before the procedure.

Conclusion:
These cases highlight that Vicryl mesh can be a valuable option in selected pediatric patients with complex inguinal hernias or large abdominal wall defects, providing effective reinforcement without immediate complications. Longer follow-up and broader studies remain necessary to evaluate long-term outcomes and safety of mesh use in children.