Laparoscopic herniorrhaphy in children

Abstract

The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females). Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females). A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia), 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia). Nine of 122 patients (6 males and 3 females) were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%). The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%): 2 cases in unilateral repair and 1 case a unilateral recurrence in a bilateral repair. No other complications were seen. Laparoscopic repair of inguinal hernia in children performed in this experience resulted a safe and effective procedure.

Our Laparoscopic Surgical technique and experience in treating pediatric inguinal hernia over the past decade

“…Of the mentioned disadvantages include violating the peritoneal cavity, longer operating time, higher costs, and higher recurrences. [1415] In contrast, the advantages reported were excellent visual exposure, improved cosmesis, the need of less oral analgesia, the benefit of evaluating the contralateral side, the need of minimal dissection, technical ease, avoiding touching the cord structures, trocar placement is identical regardless of hernia side, and the potentiality of detecting other pathology. [141516]…”

“…In our institution, the operative time of both open and laparoscopic repair is comparable, a fact that is supported by a number of studies hence negating the time disadvantage associated with laparoscopic hernia repair. [151617] Moreover, wherein open surgery, time is mainly consumed in gaining access, in laparoscopic surgery time is consumed mainly in intracorporeal suturing. However, this time goes down with experience therefore, reducing the operative time.…”

“…In open repair reported recurrence rates range between 0.2% and 0.8%, whereas the recurrence rates in laparoscopic hernia repairs ranged from 0.6% to 3.4%. [15] In a study involving 1530 patients, all of whom were operated on laparoscopically reported a recurrence rate of 0.48%. This rate is very comparable to previously published recurrence rates of open repair.…”

“…This can prevent the possibility of a contralateral metachronous hernia developing, although some argue that the rate of contralateral PPV developing into clinical hernia is small. [15] A study compared metachronous inguinal hernia (MIH) incidence after both open and laparoscopic repair and reported that MIH occurred for 0.1% of patients that underwent laparoscopic repair where MIH occurred for 2.4% for those operated on through the classical open repair. [24] The authors concluded that CPPV repair in laparoscopy reduced the rate of subsequent of MIH however, 21 CPPV needed to be closed to prevent one MIH developing.…”

Ultrasound-guided dissection and ligation of the internal inguinal ring for hernia repair in pediatrics: an experimental animal study

“…As the techniques evolve, new strategies have been applied, as the use of natural orifices, robotically assisted procedures and percutaneous laparoscopic assisted procedures, in a quest to be even less invasive. While the open techniques for indirect inguinal hernia correction, a common procedure in pediatric surgery, are well established and have had their own evolution, laparoscopic correction has emerged in this global context [1,2], peaking nowadays for some into a scar less percutaneous procedure [3].…”