Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients of all ages

Characteristics of laparoscopic inguinal hernia recurrences

“…Technical modifications and new techniques of laparoscopic inguinal hernia repair have repeatedly been presented, implying that they may obviate recurrences eventually [1][2][3]. However, recurrences still occur.…”

Laparoscopic Approach as an Alternative Option in Treatment of Pediatric Inguinal Hernia

“…Simple diagnostic laparoscopic examination enables surgical precision through enhanced visualization, magnification and ability to limit collateral damage by minimizing invasion. The reported incidence of a missed metachronous hernia following laparoscopic inspection is given as 1.1%, a figure far less than the expected traditional rate of a metachronous hernia (26,36,40) . We may conclude that, a certain number of children will be saved from an unnecessary contralateral exploration or a future hernia by using this simple technique.…”

“…It is a reciprocal approach where the base of the hernia sac is ligated at the level of the internal inguinal ring, but mostly differs from the original open technique in leaving the sac in place. Albeit the described laparoscopic techniques, there is no single laparoscopic approach that has replaced the traditional repair (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57) . The repair can be classified into two broad categories (intra or extraperitoneal) based on their approaches to the internal ring.…”

“…The repair can be classified into two broad categories (intra or extraperitoneal) based on their approaches to the internal ring. The latter is mainly a subcutaneous endoscopically assisted ligation (40,41,(53)(54)(55)57) . All mentioned approaches require different types of suture material (absorbable nonabsorbable) as well as techniques of knotting (intracorporeal, extracorporeal) and wide range of endoscopic instruments (mainly required during extraperitoneal approach) are available (36,41,54,58) .…”

“…Antonoff et al has pointed out to the higher risk of an inadvertent injury to vas deferens in the absence of a true hernia (68) . Complications that may result in infertility during hernia repair include testicular atrophy, injury to the vas deferens, iatrogenic cryptorchidism, and injury to the fallopian tubes (3,7,15,18,40,(68)(69)(70) . A recent survey declares a 5% infertility rate, medically diagnosed in males 50 years after hernia repair (71) .…”