Inguinal hernia in the International Classification of Diseases 10 reading is in the section of diseases of organs and systems of the digestive tract of class XI. K00-K93.

In block K40-K46 the code for inguinal hernia in ICD 10 looks like K40. Protrusion of the peritoneum into the opening of the inguinal lumen in men occurs 5-6 times more often than in women, since representatives of the stronger sex are more susceptible to heavy physical labor.

Localization

Paragraph K40 contains several subparagraphs that determine the types of pathology by location, for example, the following:

• double sided;
• one-sided;
• unspecified;
• oblique;
• scrotal;
• straight;
• indirect.

The second digit of the International System of Disease Classification code characterizes the localization of the protrusion of the abdominal cavity, which can be determined by a competent specialist anywhere in the world.

Pathogenesis

In ICD 10, inguinal hernia has encrypted varieties that characterize the course of the pathological process. The following pathologies are distinguished:

• infringement;
• gangrene;
• obstruction;
• combinations of the above manifestations.

All information is displayed in the diagnosis code, for example, K40.3 characterizes the presence of a hernia of unspecified localization, with obstruction, but without gangrene. The mobility of the hernial protrusion determines the severity of the pathological process. That is, a strangulated inguinal hernia may have fecal incarceration, mobile, retrograde or elastic. This question is very important in making a correct diagnosis and choosing the appropriate and most optimal way to solve the problem. Surgery is usually used.

Inguinal hernia according to ICD-10 has code K40.

Its strangulation occurs as a result of the expansion of the hernial orifice and the prolapse of part of the organs into the hernial sac. This disease is characterized by rapid development and increased symptoms.

It is important to contact as quickly as possibleb See a doctor; if treatment is delayed, death may occur. If medical assistance is provided immediately, then there will be no problems with treatment, and the person will quickly return to normal.

Inguinal hernia according to the International Classification of Diseases, Tenth Revision, has group code K40, which includes bilateral and unilateral inguinal hernias. They are divided into hernias with gangrene and without gangrene. Each type of disease has its own international code. Inguinal hernia strangulation is most often coded K40.3, K40.4, K40.9. But in some cases, a strangulated inguinal hernia according to ICD-10 may have the code K43.0.

Characteristic symptoms

The first sign is a sharp pain in the groin area, which can spreadbthroughout the entire abdominal cavity. The pain syndrome occurs acutely, immediately after severe stress.

When examining the groin, a protrusion may be detected. It is slightly swollen, hard and irreducible. When you try to straighten it with your hands, the pain only intensifies. The surrounding skin is elastic. In children, this protrusion may not be noticeable.

Another of the very first symptoms is nausea and vomiting. As the disease progresses, vomiting becomes constant. Immediately after the injury, diarrhea may occur, followed by constipation and lack of gas. Periodically there is a false urge to defecate.

If the bladder is pinched, the patient experiences a frequent urge to urinate. The process is painful. Pain shock of 1-2 degrees (moderate and severe) may be caused. At the same time, the general condition of a person worsens. The temperature may rise.

In young children, a strangulated inguinal hernia is accompanied by anxiety and crying. Older children complain of pain in the groin.

The longer the disease develops, the stronger the pain becomes and spreads to the entire abdominal area. Symptoms develop faster and more intensely. The general condition also begins to deteriorate. For example, at the very beginning of the infringement the patient generally feels good, but a day later his condition sharply worsens. A fever and constant vomiting appear.

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Causes and risk groups

The reasons for the infringement are:

• overvoltage;
• lifting weights;
• severe cough;
• long crying in children.

As a result of these phenomena, the pressure in the abdominal cavity increases, and the inguinal hernia is stretched more strongly, and some organs fall out. After the tension is relieved, the muscle ring narrows back, and the organs remain pinched. With this type, the contents of the hernia can include parts of the intestine, as well as the ovaries, fallopian tube, and bladder.

The fecal form occurs due to accumulations of feces in the adductor colon. The accumulation of feces begins to put pressure on the abductor muscle, and a pinching gradually forms. In this case, the intestines end up in the hernial sac. Typically, such processes are observed in older people.

An inguinal hernia can be strangulated in 20% of 100%. Among middle-aged and elderly people, males are most often affected. In childhood, the disease occurs equally in both boys and girls.

Diagnostic measures

The disease is diagnosed by a surgeon and an external examination is performed. The doctor examines the groin area. A protrusion is detected in the right or left side (less often in both). It can be small in size; in infants it is not always easy to detect it due to its small size and developed subcutaneous fat.

The protrusion is dense, and pain occurs on palpation. When changing position or coughing, the hernia does not change its shape; in addition, when turning, it can become denser. There may be redness or swelling in the area of ​​the hernia.

A strangulated inguinal hernia cannot be reduced.

Difficulties in diagnosis may arise if there is an ovary or fallopian tube in the hernial sac (this occurs when strangulation occurs in women and girls). These organs are susceptible to necrotization very quickly (within a few hours). Because of this, sharp pain occurs when touched. For this reason, female representatives are immediately sent for surgery.

Diagnosis of young children also has its own characteristics. When examined, they experience sharp pain, as a result of which they cry loudly, may experience painful shock, and kick their legs. This happens due to physiological characteristics. Young children have accelerated blood flow in the intestines, which is why pain on palpation is stronger than in adults.

Necessary treatment

An inguinal hernia that is strangulated can only be treated surgically. It cannot be dealt with without the intervention of a surgeon, and if treatment is delayed and not provided, necrosis of the organs located in the hernial sac begins to occur (organ death).

Once the diagnosis is made, the patient is immediately sent for surgery. The only exceptions are infants (boys).

In young children, the muscles are still weak and more elastic than in adults. This facilitates the possibility of self-reduction of the contents of the hernial sac. In children, strangulation occurs as a result of strong crying, the abdominal muscles tense and organs fall out. Infringement stimulates motor activity and increases muscle tension.

If the child is calmed, the muscle ring relaxes and the contents are reduced manually. For this purpose, conservative treatment is first carried out (provided that less than 8 hours have passed since the infringement).

First, the baby is injected with a pantopon solution, its concentration depends on age. After this, a bath is made with water at a temperature of 37-38 degrees Celsius. You can put a heating pad on your tummy. If reduction does not occur within an hour, then it is prepared for surgery.

Girls have the same body characteristics as boys, but they are immediately sent for surgery. This is because they usually have an ovary or part of their fallopian tube that falls out. The death of these organs begins within 5 hours, so urgent surgical intervention is indicated. Otherwise, the girl will remain infertile.

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During surgical intervention, the contents are first eliminated, and only then the plastic. Depending on what stage (temporary) the operation occurs, the organs in the hernial sac may already be dead. Based on the assessment of the degree of necrosis, there are three solutions:

• If the intestine is in a healthy condition, then the surgeon sets it and only then performs plastic surgery.
• In the case when necrosis has already begun, but only at an early stage, the patient is given injections, the organ is set and plastic surgery is performed.
• If part of the organ is dead, it is removed, the intestine is sutured, set into the cavity and plastic surgery is performed.

If a strangulated inguinal hernia occurs, you should immediately contact a surgeon. This disease is diagnosed very simply, so there will be no problems. The only treatment option for female adults and children is surgery. In male infants, you can try to eliminate the problem by repositioning it. After treatment, postoperative rehabilitation is required.

Protrusion of elements of the abdominal organs through the inguinal canal is characterized as an inguinoscrotal hernia. This condition can be congenital or appear simultaneously with age-related changes, and is observed much more often in the male part of the population than in women.

The pathology responds well to treatment, especially timely treatment. Advanced cases can threaten strangulation of the hernial sac and necrosis of the strangulated organs.

ICD 10 code:

• K 40 – inguinal hernia.
• K 40.0 – bilateral inguinal hernias with symptoms of obstruction.
• K 40.1 – bilateral inguinal hernias with gangrenous complications.
• K 40.2 – uncomplicated bilateral inguinal hernias.
• K 40.3 – unilateral or unspecified, with symptoms of obstruction.
• K 40.4 – unilateral or unspecified with gangrenous complications.
• K 40.9 – unilateral or without specification, uncomplicated.

Causes of inguinoscrotal hernia

The factors that determine a person’s predisposition to the occurrence of an inguinal-scrotal hernia are:

• heredity;
• age after 50 years;
• neurological pathologies affecting the nerve innervation of the abdominal wall;
• obesity, extra pounds.

Functional factors that can lead to the appearance of pathology include the following:

• excessive physical activity on the abdominal area;
• chronic difficulty defecating, constipation;
• prostate adenoma, accompanied by urination problems;
• chronic coughing attacks.

Pathogenesis of the disease

The main causes of this disease are closely related to the structural features of the muscular-ligamentous apparatus of the abdominal and inguinal zone of a particular patient. The most important point is the condition of the inguinal canal itself and the inguinal ring. Weakness of these organs predisposes to the appearance of a hernia.

Inguinoscrotal hernias are divided into the following types:

• By location:
  • On the one side;
  • on both sides.
• Typical:
  • direct hernia;
  • oblique hernia.
• According to the variant of occurrence:
  • congenital type;
  • acquired type.
• By degree of development:
  • initial form;
  • inguinocanal form;
  • complete indirect inguinal hernia;
  • inguinoscrotal hernias;
  • giant shape.
• According to the nature of the flow:
  • without complications (with and without reduction);
  • with complications (with strangulation, with coprostasis, with inflammation, etc.).
• By severity:
  • simple hernia;
  • transitional form;
  • complex hernia.

Symptoms of inguinoscrotal hernia

An oblique inguinal-scrotal hernia is more common than a direct one. Direct hernia occurs only in 5-10% of cases, and even then mainly in older people. In most cases, such protrusion is bilateral. An indirect hernia usually appears in patients from adolescence to middle age, usually on one side.

One of the most characteristic symptoms of hernial pathology is a tubercle in the form of swelling in the groin area. An oblique inguinal-scrotal hernia has an oblong shape, it is located along the inguinal canal and is often lowered into the scrotum. If the protrusion is large, then part of the scrotum can be significantly enlarged, the skin on it becomes tense, and there is a visible deviation of the penis to the opposite side. With a giant hernia form, the penis may be buried in the folds of skin.

A direct inguinal-scrotal hernia has a relatively round shape and is located in the middle section of the inguinal ligament.

In situations where the hernia defect is located above the intended exit of the inguinal canal opening, it is necessary to exclude peri-inguinal or interstitial pathology.

Inguinoscrotal hernia in men manifests itself as severe pain. Pain may appear when palpating the area of ​​the protrusion, after physical activity, but the pain subsides with rest. Individually, signs such as general weakness and discomfort, dyspeptic symptoms (attacks of nausea, vomiting) may appear.

Inguinoscrotal hernia in children can form at any age, most often on the right side. The first signs can be seen with the naked eye:

• when the abdomen tenses, during laughter, sneezing, coughing, a tubercle with soft contents appears in the groin area;
• the tubercle disappears at rest or hides when pressed.

Sometimes discomfort and mild pain may appear, mainly after physical activity.

Inguinoscrotal hernia in newborns It is innate in nature and is formed inside the mother’s womb. The pathology can be determined already in the first months of the baby’s life: a lump in the groin appears and becomes larger during the child’s screaming and restlessness and disappears when the baby calms down. The tubercle is painless to the touch, has a round or oval shape, and is easily reducible.

A strangulated inguinal-scrotal hernia is a dangerous condition and requires urgent medical attention. How to recognize such a complication?

• The skin at the site of the protrusion becomes purple or bluish.
• Severe pain, nausea, or vomiting occurs.
• Disorders of stool, flatulence, and loss of appetite appear.

When pinched, the tubercle becomes very painful when touched. It is no longer possible to set it back, whereas an unstrangulated inguinal-scrotal hernia easily hides when pressed with a finger.

Constipation with an inguinal-scrotal hernia occurs when a loop of intestine is strangulated - a condition occurs that fully corresponds to the characteristics of intestinal obstruction. Constipation may be accompanied by a significant deterioration in health, bloating, belching, heartburn, and vomiting. It is pointless to wait for relief in such a state - it is necessary to urgently call “emergency help”.

Consequences

Complications of inguinal-scrotal hernia develop in the absence of timely treatment:

• strangulation of the hernial tubercle is the most common consequence, which can only be eliminated by surgical methods;
• necrosis of organs caught in the pinched hernial sac - intestinal loops, areas of the omentum, bladder;
• peritonitis - a dangerous inflammatory reaction that spreads to the entire abdominal cavity (can also occur as a result of strangulation);
• acute attack of appendicitis - inflammation of tissue in the appendix, which occurs as a result of compression of the vessels of the appendix by the inguinal ring;
• The clinical consequences of an inguinal hernia can include digestive disorders, intestinal dysfunction, bloating, etc.

The most serious complication is considered to be a strangulated hernia - this situation requires urgent medical attention, with hospitalization in a hospital and emergency surgery.

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Diagnosis of inguinoscrotal hernia

The doctor makes a diagnosis based on the patient’s complaints, as well as the results of an external examination. Palpation is carried out using the index finger: with an inguinal-scrotal hernia, the tubercle is easily palpated, but with a femoral hernia, it is quite difficult to palpate.

In children, the doctor simultaneously determines the descent of the testicles into the scrotum, their size and shape, and the absence of varicocele. The condition of the lymph nodes in the groin area is mandatory.

The condition of the hernia defect is checked in the horizontal and vertical position of the patient.

• Ultrasound scanning of the scrotum, which helps determine the contents of the hernial sac (for example, part of the bladder or part of the intestine). Additionally, using ultrasound, you can distinguish a hernia from testicular hydrocele;
• The diaphanoscopy method is a light transillumination of the scrotum - a simple and inexpensive diagnostic method. If the contents of the bag are liquid, then the rays are illuminated through the tubercle without problems. A denser structure will not allow the rays to pass through, and the light will appear dim or uneven.

Treatment of inguinoscrotal hernia

Drug therapy for inguinal-scrotal hernia disease is ineffective, and therefore this pathology can only be cured surgically. The operation can be performed from the age of 6 months (it is not advisable for newborns to undergo the intervention due to the use of general anesthesia).

Anesthesia is usually combined with tranquilizers and drugs for local anesthesia - this helps prevent the occurrence of severe pain in the postoperative period.

Surgery for inguinal-scrotal hernia is called herniotomy:

• the doctor makes an incision in the inguinal canal area;
• cuts off and sutures the hernial formation;
• elements of organs that are pinched are restored to their physiological place - the normal anatomical structure of the inguinal and abdominal region is restored.

During the operation, the surgeon ensures that the spermatic cord and efferent duct are not damaged.

As a rule, herniotomy surgery is not complex - the procedure itself lasts no more than half an hour. Most often, the patient is discharged the next day, but bed rest is recommended for another three days. If the doctor applied regular stitches, they are removed after 7-8 days.

Traditional treatment for a hernia - applying tight bandages, applying coins, lotions, magnets, compresses - is a useless exercise. By engaging in such treatment, the patient only wastes time, which can lead to complications in the form of a strangulated hernia, which will require urgent surgical intervention. If the patient was operated on within 2 or 3 hours after the hernia was strangulated, then such an operation is successful in most cases. Delay in intervention can lead to serious complications, and in some situations, even fatal consequences.

Bandage for scrotoinguinal hernia

There is only one conservative technique that is used in the treatment of inguinal-scrotal hernia pathologies - this is a bandage.

In what cases may a doctor prescribe wearing a bandage:

• large hernial formations, if it is impossible to perform surgery for one reason or another;
• reappearance of pathology after surgical treatment;
• the presence of contraindications to surgical intervention (age restrictions, cardiovascular pathologies, problems with blood clotting, etc.);
• childhood diseases in which surgery is postponed indefinitely.

At the same time, the bandage does not radically cure the disease. Its purpose is to alleviate the patient’s condition, stop the increase in hernial protrusion and prevent strangulation. However, if the patient stops using the bandage, then all signs of pathology return.

So, what does wearing a bandage give:

• the degree of discomfort decreases;
• the patient's ability to work returns;
• the hernia loses its tendency to worsen and strangulate.

The bandage is put on every morning, on the naked body, in a horizontal position. At first, wearing it may be a little uncomfortable, but after a few days the patient gets used to it and does not notice any discomfort. Of course, choosing the right bandage is important: a medical specialist at a clinic or pharmacy can help with this.

The bandage can be removed before going to bed, but if the patient experiences coughing attacks at night, it is not necessary to remove the support device.

As practice shows, wearing a bandage is a temporary phenomenon, and sooner or later the patient still has to decide on surgery.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2017

Bilateral inguinal hernia without obstruction or gangrene (K40.2), Unilateral or unspecified inguinal hernia without obstruction or gangrene (K40.9)

Pediatric gastroenterology, Pediatrics, Pediatric surgery

General information

Brief description

Approved
Joint Commission on Healthcare Quality
Ministry of Health of the Republic of Kazakhstan
dated June 29, 2017
Protocol No. 24

Inguinal hernia is a pathological protrusion of the hernial sac (vaginal process of the peritoneum) together with the hernial contents (loop of intestine, strand of omentum or ovary) in the groin area.

Congenital inguinal hernias in children are a local manifestation of mesenchymal deficiency syndrome. Inguinal hernias in childhood are usually oblique, that is, they pass along the inguinal canal through its internal and external openings. The structural anatomy of a hernia includes: hernial orifices - defects of the abdominal wall of congenital or post-traumatic origin; hernial sac - a stretched sheet of parietal peritoneum; hernial contents - abdominal organs displaced into the hernial sac. The hernial sac is a partially or completely unobliterated vaginal process of the peritoneum.

INTRODUCTORY PART

ICD-10 code(s):

Date of protocol development/revision: 2017

Abbreviations used in the protocol:

Classification

Classification:

I. By etiology:

1) Congenital inguinal hernia;
2) Acquired inguinal hernia.

II. In relation to the inguinal ring:
1) Indirect inguinal hernia;
2) Direct inguinal hernia.

III. Depending on the level of obliteration of the vaginal process of the peritoneum and the projection of the hernial sac:
1) inguinal;
2) inguinal-scrotal;
a) rope;
b) testicular.

IV. By localization:
1) Right-handed;
2) Left-handed;
3) Double-sided.

V. Recurrent.
Hernias are also classified as reducible (when the contents of the hernial sac are freely reduced into the abdominal cavity), irreducible and strangulated. Irreversible inguinal hernias do not cause acute clinical manifestations and are rare, more often in girls when the ovary is fixed to the wall of the hernial sac. Strangulated inguinal hernias due to compression of the contents of the hernial sac in the aponeurotic ring and disturbances in the blood supply to the strangulated organ are manifested by an acute symptom complex.
Depending on the structure of the hernial sac, a sliding inguinal hernia can be distinguished. In this case, one of the walls of the hernial sac becomes the wall of an organ (for example, the bladder, ascending colon).
Congenital inguinal hernia is predominantly unilateral, with the right being 3 times more common and observed mainly in boys. Among inguinal-scrotal hernias, the most common are cord hernias (90%), in which the processus vaginalis is not obliterated in the upper and middle parts, but is separated from the lower , which formed the testicular membrane itself. With a testicular hernia, observed in 10% of cases, the peritoneal process remains unobliterated throughout its entire length, so it is sometimes mistakenly believed that the testicle lies in the hernial sac. In fact, it is separated from it by serous membranes and only protrudes into its lumen.
Acquired inguinal hernias in children are extremely rare, usually in boys over 10 years of age with increased physical activity and severe weakness of the anterior abdominal wall.
Direct inguinal hernias in children are extremely rare and in the vast majority of cases are associated with congenital or iatrogenic pathology of the anterior abdominal wall.

Diagnostics

METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

Diagnostic criteria

Complaints: for a tumor-like protrusion in the inguinal, inguinal-scrotal area.

History of the disease: The reason for the examination is a clinical examination of children or complaints from parents about the periodic appearance of a tumor-like formation in the groin area or an increase in the size of the scrotum.

Physical examinations:
Upon inspection: The clinical picture of an uncomplicated inguinal hernia is manifested by the presence of a tumor-like formation in the groin area, which increases with screaming and anxiety and decreases or disappears in a calm state. The protrusion has a round (for inguinal) or oval (for inguinal-scrotal hernia) shape.
On palpation elastic consistency, painless, hernial protrusion disappears independently when the patient moves to a horizontal position, or as a result of finger pressure. At the same time, a characteristic rumbling sound is clearly audible. After reduction of the hernial contents, the enlarged external inguinal ring is palpated.

In girls, the protrusion with an inguinal hernia has a round shape and is located at the external inguinal ring. If the hernia is large, the protrusion may descend into the labia majora.
Older children are examined in a standing position, with abdominal muscle tension and coughing.

Laboratory research: No.

Instrumental research (UD - B):
· Ultrasound examination of the groin area, scrotum.

List of necessary studies for planned hospitalization:
general blood test;
general urine analysis;
· biochemical blood test (total protein and its fractions, urea, creatinine, ALT, AST, glucose, total bilirubin and its fractions, amylase, potassium, sodium, chlorine, calcium);
· coagulogram (prothrombin time, fibrinogen, thrombin time, INR, APTT);
· blood test for hepatitis B, C;
· blood test for HIV;
feces on worm eggs
· ECG - to exclude heart pathology before the upcoming operation;
· Echocardiography - if congenital heart disease is suspected;
· consultation with specialists - according to indications (anemia - hematologist, heart pathology - cardiologist, etc.).

Indications for consultation with specialists:
· consultation with narrow specialists - according to indications.

Diagnostic algorithm:

Differential diagnosis

Differential diagnosis and rationale for additional studies:

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Treatment

Treatment (outpatient clinic)

OUTPATIENT TREATMENT TACTICS : These patients are treated only at the inpatient level. Before surgery, at the stage of preparation for surgical treatment, wearing a special bandage; for older children, it is recommended to avoid physical activity, eliminating factors that increase intra-abdominal pressure (prevention of cough, constipation).

Non-drug treatment: No.

Mdrug treatment: In the absence of complications, drug therapy is not indicated.

List of basic and additional medicines: No.

Surgical intervention: No.

Further management:
· sending children to a surgical hospital for planned surgery.

No.

Treatment (inpatient)

TREATMENT TACTICS AT THE INPATIENT LEVEL : The only radical method of treating an inguinal hernia is surgery.

Non-drug treatment:
· Mode ward, in the early postoperative period - bed.
· Age diet: breastfeeding, table No. 16, 15.

Mdrug treatment (see table 1 below):
· analgesic therapy;
· symptomatic therapy.

List of essential medicines:
· pain relief with non-narcotic analgesics - for adequate pain relief in the postoperative period.

Surgical intervention:
· Hernia repair.
Indications:
· clinical and instrumental confirmation of the diagnosis of inguinal hernia.
Contraindications:
acute inflammation of the upper respiratory tract;
· acute infectious diseases;
· severe malnutrition, rickets;
· hyperthermia of unknown etiology;
· purulent and inflammatory skin changes;
absolute contraindications for the cardiovascular system.

Further management:
After being discharged home, school-age children are exempt from classes for 7-10 days and from physical activity for 2 months. Subsequently, a surgical follow-up of the child by a surgeon is necessary, since in 3.8% of cases recurrences of the hernia occur, requiring re-operation.

Indicators of treatment effectiveness:
· disappearance of hernia manifestations after surgery;
· healing of a postoperative wound by primary intention;
· absence of ligature fistulas and manifestations of hernia recurrence in the long-term postoperative period.

Table 1. Drug comparison table:

Hospitalization

INDICATIONS FOR HOSPITALIZATION, INDICATING THE TYPE OF HOSPITALIZATION

Indications for planned hospitalization:
· children with a diagnosed inguinal hernia in the absence of absolute contraindications to surgery;
· age of the child - modern methods of pain relief allow the operation to be performed at any age, starting from the neonatal period. Due to relative contraindications (previous diseases, malnutrition, rickets, etc.), in uncomplicated cases the operation is postponed to an older age (6-12 months).

Indications for emergency hospitalization:
· Clinic for strangulated inguinal hernia.

Information

Sources and literature

1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2017
   1. 1) Yu.F. Isakov, A.Yu. Razumovsky. Pediatric surgery - Moscow, 2015 - pp. 523-525 2) Pediatric Surgery: Diagnosis and Treatment Christopher P. Coppola, Alfred P. Kennedy, Jr., Ronald J. Scorpio. Springer, 2014; 207. 3) Daniel H Teitelbaum, Hock Lim Tan, Agostino Pierro. Operative pediatric surgerySeventh edition. CRCPress, 2013; 277-288 4) P. Puri, M. Golvart. Atlas of pediatric surgical surgery. Translation from English edited by T.K. Nemilova. 2009 pp. 153-159. 5) Endoscopic surgery in children. A.F. Dronov, I.V. Poddubny, V.I. Kotlobovsky. 2002 – pp. 208-212. 6) K.U. Ashcraft, T.M. Holder "Pediatric Surgery" Hardford. St. Petersburg 1996 Translation from English edited by T.K. Nemilova.p. 251-260. 7) Yu.F. Isakov, A.F. Dronov Children's surgery national guide. Moscow 2009 pp. 685-690. 8) Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial. Gause CD, Casamassima MG, Yang J., etc.PediatrSurg Int. 2017 Mar;33(3): 367-376. 9) Chan KL, Hui WC, Tam PKH. Prospective, randomized, single-center, single-blind comparison of laparoscopic vs open repair of pediatric inguinal hernia. Surgical Endoscopy 2005; 19: 927-32. 10) Melone JH, Schwartz MZ, Tyson DR et al. Outpatient inguinal herniorrhaphy in premature infants: is it safe? Journal of Pediatric Surgery 1992; 27: 203-8. 11) Niyogi A. Tahim AS, Sherwood WJ et al. A comparative study e)
      
      

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