The pathological evaluation of the pediatric inguinal hernia sac

Background: The College of American Pathologists has suggested that institutions should establish guidelines for the evaluation of the hernia sac. In addition, some states require the submission of this tissue for pathological evaluation. Yet, neither evidence-based guidelines nor published reviews for the evaluation of the pediatric hernia sac are available. Therefore, this retrospective study was conducted to document experience with the evaluation of the pediatric hernia sac. Methods: All reports of the evaluation of hernia sacs submitted to the Department of Pathology during an 8-year period were reviewed. The case of any report that differed in any way from 'consistent with hernia sac' was evaluated for the effect of the findings on the clinical course. Results: A total of 7,924 hernia sacs were submitted on 6,034 patients. Microscopic evaluation was performed on 534. A total of 7,567 (95.4%) submitted specimens on 5,743 patients were 'consistent with hernia sac' and demonstrated no other findings. Three hundred fifty- seven specimens contained findings in addition to hernia sac. In no patient did the results of the evaluation have an effect on the patient care. Conclusions: There is strong evidence that the routine pathological evaluation of pediatric hernia sacs offers little relevant clinical information. Mandatory tissue submission of hernia sacs should be reconsidered.