Inguinal hernia containing the uterus in the pediatric patient: a systematic review

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 the Synthesis without Meta-analysis (SwIM) 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, finding one patient with inguinal uterus hernia that was included in the statistical analysis. Results 36 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 nor 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 post-operative complications nor recurrences have been described. Conclusions Data obtained do not allow us to draw univocal conclusions on whether which is the best management in these patients: it is still unclear if an elective approach in an asymptomatic patient may 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 nor recurrences.