Incidence and management of the inguinal hernia during laparoscopic orchiopexy in palpable cryptoorchidism: preliminary report

Abstract

During the laparoscopic approach of undescended testis, an associated inguinal hernia is a frequent finding that must be treated at the same time. The objective of this presentation is to show the incidence and management of the inguinal hernia that were found during laparoscopic orchidopexy, reporting how the scar tissue will join the edges of the canal and the parietal peritoneum will grow above. Between January 1999 and December 2002, 31 patients with 33 palpable and nonpalpable undescended testes were treated by laparoscopic orchidopexy. Patients were between 6 months and 9 years. We used four ports, and 2 mm instrument. When an associated inguinal hernia were found we only removed the membranes of the processus vaginalis and did not close the defect. All cases were treated by the same surgeon. The average surgical time was 50 min that included the orchiopexy and the treatment of the associated inguinal hernia. We found inguinal hernia in 23 cases (69.9%). We did not find any inguinal hernia in the opposite side of the undescended testis. In two patients with bilateral undescended testis that were approached in two stages 3 months later we confirmed the closure of the hernia defect. These 23 patients have 21.5 months average follow up and confirm no recurrence. With an average follow up of 21.5 months, we found no inguinal hernia in any of the patients. A larger volume study with longer follow up is needed to confirm that there is no need for closure of the internal inguinal ring during laparoscopic orchidopexy.

Laparoscopic Pediatric Inguinal Hernia Repair: No Ligation, Just Resection

“…1 The fundamentals of our theory are based on a previous publication in which we described the management of the inguinal hernia during laparoscopic orchidopexy. 2 During the pulling of the testicle into the abdominal cavity, we resected the associated hernia sac. Then, we descended the testicle through a new path, medial to the epigastric vessels.…”

Laparoscopy-assisted orchiopexy for recurrent undescended testes in children

“…In addition, we found that 8 cases were associated with inguinal hernia, suggesting that the first orchiopexy failed because an inadequate operation was performed. In a recent study, Riquelme et al [14] reported that the resection of processus vaginalis as the most important step of pediatric hernia repair, even without closure of the internal ring during laparoscopic orchidopexy. The hernia space can be occupied by scar tissue, and the deperitonealized area will close completely over the internal inguinal ring [14].…”

“…In a recent study, Riquelme et al [14] reported that the resection of processus vaginalis as the most important step of pediatric hernia repair, even without closure of the internal ring during laparoscopic orchidopexy. The hernia space can be occupied by scar tissue, and the deperitonealized area will close completely over the internal inguinal ring [14]. We agree to this opinion based on our findings in previous cases of laparoscopic orchidopexy.…”

Sac ligation in inguinal hernia repair: A meta-analysis of randomized controlled trials

“…In the era of tension-free mesh repair, some surgeons perform hernia sac excision without ligation, whereas others adopt hernia sac reduction alone [4,5]. During laparoscopic hernioplasty, the associated hernia sac is left unsutured with no consequences [6,7].…”