A True Laparoscopic Herniotomy in Children: Evaluation of Long-Term Outcome

Abstract

Thirteen years of experience with a laparoscopic technique mimicking, as closely as possible, the classical open technique are presented in this report. Consecutive laparoscopic herniotomies in 385 children (178 girls and 207 boys; age 0.13 to 16.8 years) with a total of 525 hernia repairs were included into a retrospective review. Overall, 95% of children were treated on a day-care basis; all operations were completed laparoscopically. Mean operation time was 32.1 minutes (26.2 for unilateral hernias and 34.5 for bilateral). In total, 10.1% of children presented with clinically bilateral hernias, whereas 29.2% of clinical unilateral hernias had a patent contralateral processus vaginalis. We discovered femoral hernias in 2.6% and direct inguinal hernias in 0.5% of the cases. In 79 cases, a concomitant of umbilical herniorraphy was performed. There were no cases of testicular malposition or atrophy. We had a 1% hernia recurrence rate. Cosmetic outcome was excellent. Laparoscopy provides the surgeon with a superior diagnostic tool, facilitating the diagnosis of any kind of inguinal hernia or controlateral patent processus vaginalis and its repair in the same session; surgery- and anesthesia-related stress is minimized. This makes it an interesting alternative to the open repair of inguinal hernias in children, providing an excellent view on the cord structures and leaving them, as well as the testis, untouched.

Laparoscopic single instrument closure of inguinal hernia in female children: A novel technique

“…Despite his use of dissection technique, he had 4 recurrent hernias (1 girl and 3 boys) in his series (1.04% of his treated children and 0.76% of his hernia repairs). He considered his rate of recurrence being in the lower average when compared to that reported in the literature (recurrence rate after laparoscopic repair has been reported at between 0 and 4.4%) [23].…”

“…From their opinion this technique requires no more time than an open operation, and that pain and discomfort resolved very quickly [16]. Giseke et al [23] reported that, laparoscopic hernia repair should stay as close as possible to the open approach. So, they considered the use of laparoscopic reproduction of the inguinal approach, in their series on 385 children (178 girls and 207 boys).…”

Single-incision laparoscopic closure of inguinal hernia in female children: a simplified technique

“…Becmeur et al [20] concluded that pediatric inguinal hernia must be treated in the same manner as that carried out for open surgery; this is achieved with complete separation of the sac at the IIR, and suturing of the peritoneum at the IIR. Giseke et al [21] further reported that laparoscopic hernia repair in children should be a reproduction of the open inguinal approach with dissection of the sac at the IIR. In 2015, Lee et al [22] reappraised one critical concern in their publication entitled "A purse-string suture at the level of internal inguinal ring, taking only the peritoneum leaving the distal sac: is it enough for inguinal hernia in pediatric patients?"…”

Der Stellenwert der minimalinvasiven Chirurgie bei der Behandlung der Leistenhernie und Pylorusstenose

“…Um diese Techniken anwenden zu können, sollte der Chirurg gut intrakorporal knoten können. Eine Reihe von Variationen dieser Technik sind publiziert [21,22]. 2.…”