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Laparoscopic herniorrhaphy in children.

C M Gorsler1, F Schier

  • 1Department of Pediatric Surgery, University Medical Center of Luebeck, Germany. clarkgorsler@t-online.de

Surgical Endoscopy
|February 13, 2003
PubMed
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Laparoscopic herniorrhaphy in children offers excellent cosmetic results and avoids groin incisions. This safe and reproducible technique effectively treats inguinal hernias, with a low recurrence rate and minimal complications.

Area of Science:

  • Pediatric Surgery
  • Minimally Invasive Surgery
  • Laparoscopic Procedures

Background:

  • Clinical experience with 403 inguinal hernias in 279 children treated laparoscopically.
  • Purely laparoscopic approach using 2-mm instruments, avoiding groin incisions.

Purpose of the Study:

  • To evaluate the safety, efficacy, and outcomes of a purely laparoscopic approach for pediatric inguinal hernias.
  • To assess the incidence of contralateral patent processus vaginalis (PPV) in pediatric inguinal hernias.

Main Methods:

  • Laparoscopic herniorrhaphy in children aged 4 days to 15 years.
  • Use of a 5-mm laparoscope and two 2-mm needle holders.
  • Closure of inguinal rings with Z-sutures of nonabsorbable material.

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Main Results:

  • Mean operative time: 14 min (unilateral), 21 min (bilateral).
  • Contralateral PPV rates: 45.2% in girls, 21.9% (right) and 8% (left) in boys.
  • Recurrence rate: 2.7%; hydroceles: 1.7%; testicular atrophy: 1 case; missed hernias: 2.3%.

Conclusions:

  • Laparoscopic herniorrhaphy is safe, reproducible, and technically easy for experienced surgeons.
  • Excellent cosmetic outcomes and effective treatment for pediatric inguinal hernias.
  • Identifies defect type and allows immediate treatment; bilaterality is not a concern.