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The efficacy of laparoscopy in detecting and treating associated congenital malformations in children
C Esposito1, A Centonze, A Settimi
1Chair of Pediatric Surgery, Magna Graecia University, Catanzaro, Italy. ciroesp2@unicz.it
Insights
Laparoscopy in children offers a magnified view, enabling the detection of unexpected conditions like a direct inguinal hernia during surgery for GERD and another hernia. This minimally invasive approach successfully treated both pathologies, preventing recurrence.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Severe gastroesophageal reflux disease (GERD) and right inguinal hernia are common pediatric surgical conditions.
- Laparoscopic Nissen fundoplication is a standard procedure for GERD.
- Inguinal hernias in children are typically repaired via open surgery.
Observation:
- A 3-year-old girl with severe GERD and a right inguinal hernia underwent laparoscopic Nissen fundoplication.
- Intraoperative exploration using laparoscopy revealed an unexpected direct inguinal hernia alongside the oblique external hernia.
- Both hernias were successfully treated laparoscopically through the same port sites.
Findings:
- Laparoscopy provided a magnified view, facilitating the diagnosis of a coexisting direct inguinal hernia.
- The simultaneous laparoscopic repair of both hernias was achieved without enlarging the incision.
- One-year follow-up showed no GERD recurrence and no recurrence of the inguinal hernias.
Implications:
- Laparoscopy enhances diagnostic capabilities in pediatric surgery by allowing comprehensive abdominal exploration.
- This case highlights the potential for laparoscopy to detect and treat associated pathologies that might be missed in open surgery.
- Minimally invasive techniques can improve outcomes and reduce the risk of recurrent hernias in pediatric patients.
Abstract:
One of the main advantages of laparoscopy in children is the fact that it enables a magnified view and the possibility to explore the whole abdominal cavity. This case report clearly shows these advantages. We report the case of a 3-yr-old girl, suffering from severe GERD and right inguinal inguinal hernia, who had already been operated at birth for esophageal atresia. We performed a laparoscopic fundoplication according to Nissen and, at the end of procedure, we decided to turn the optic down to control the right inguinal region to confirm the presence of an inguinal hernia. To our great surprise we found a right oblique external hernia as well as a direct inguinal hernia on the same side. Both hernias was treated successfully in laparoscopy. At a 1-year follow-up, the patient presented no reflux and no recurrence of the inguinal hernias. The laparoscopy in this case permitted operation on two different pathologies involving the upper and lower parts of the abdominal cavity using the same ports and without enlarging the incision, as would happen in laparotomy. The main relevance of this case is that laparoscopy allowed the detection of an associated pathology like a direct inguinal hernia that would have been certainly overlooked in open surgery and could have caused a recurrent hernia if operated via open surgery.
