The incidence of spermatic cord structures in inguinal hernia sacs from male children

Inguinal herniorrhaphy is a common surgical procedure in children. Controve rsy exists regarding the usefulness of microscopic examination of hernia sa cs, and changes in reimbursement schemes have heightened this controversy. We summarize our experience with histologic examination of these specimens to establish benchmarks for the number of spermatic cord structures in ingu inal hernia sacs from male children. A 14 1/2 consecutive calendar year review of pathology reports and histolog ic sections of hernia sacs was conducted at a tertiary care children's hosp ital. Of 7,314 males (range newborn to 19 years old), 65% had bilateral and 29% had unilateral herniorrhaphy (6% unknown). Seventeen cases contained v as deferens (0.23%); 22 had epididymis (0.30%); and 30 had embryonal rests (0.41%). Either vas deferens or epididymis was found in 0.53% of patients. No cases contained bilateral vas deferens, bilateral epididymis. or vas def erens in one side with epididymis in the contralateral side. Three hernia s acs contained co-existing vas deferens and epididymis. Our study helps to provide surgeons with information for preoperative couns eling regarding potential injury to the vas deferens or epididymis. This st udy provides baseline comparison data for quality improvement programs. We believe that each institution should weigh the costs, risks, and benefits o f performing microscopic examinations on hernia sacs, depending on their ow n experience and data.