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["No-puncture-laparoscopy" in hernia management in childhood--reliable complement to established therapy concepts]
1Chirurgische Klinik I, Universität Ulm.
Insights
Intraoperative laparoscopy during unilateral hernia repair helps identify children needing bilateral surgery. This minimally invasive approach avoids a second operation and hospitalization, with no observed complications.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Laparoscopy
Context:
- Unilateral inguinal hernias in children often have contralateral patent processus vaginalis.
- Management of contralateral patent processus vaginalis remains controversial.
- 50% of children with unilateral hernias have contralateral patent processus vaginalis.
Purpose:
- Evaluate intraoperative laparoscopy's utility in managing contralateral patent processus vaginalis.
- Assess laparoscopy as a non-puncture technique via the hernia sac.
- Determine if laparoscopy can guide decisions for bilateral open surgery.
Summary:
- 112 children (6 months-7 years) with unilateral hernias underwent intraoperative laparoscopy.
- A type III internal inguinal ring (wide-open contralateral ring) was identified in 19 patients (17%).
- Laparoscopy took a median of 6 minutes with no complications.
Impact:
- Intraoperative laparoscopy accurately identifies patients benefiting from bilateral open surgery.
- This technique avoids a second hospitalization and unnecessary routine bilateral exploration.
- Laparoscopy provides excellent visualization for examining incarcerated bowel post-repositioning.
Background:
Approximately 50% of children with a clinical unilateral inguinal hernia display a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia. The management of this problem is still controversial. The purpose of this study was to evaluate the usefulness of intraoperative laparoscopy in a non-puncture technique through the opened hernia sack.
Method:
In 112 children (age 6 months to 7 years) with clinical unilateral hernia laparoscopy (5 mm laparoscope, 30 degrees and 70 degrees). In cases of a wide-open contralateral internal inguinal ring (type III) open surgical exploration was performed.
Results:
Nineteen patients (17%) fulfilled the laparoscopic criteria of a type III ring; the diagnose was confirmed during open contralateral exploration. Fourteen of these patients were younger than two years. The median time for laparoscopy was 6 min (3-11 min). No complications associated with the laparoscopy were observed.
Conclusions:
Intraoperative laparoscopy during unilateral hernia repair allows the identification of patients who profit from bilateral open surgery during the same operation with little additional operating time and so far with no resulting complications. Application of this method may avoid a second hospitalization and operation, as well as an unnecessary routine bilateral open exploration. As an additional source of information through excellent visualization of the abdominal cavity, this method proved helpful to examine incarcerated bowel after repositioning.