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Laparoscopic inguinal hernia repair-a prospective personal series of 542 children
1Department of Pediatric Surgery, University Medical Center Mainz, 55101 Mainz, Germany. schier@kinderchir.klinik.uni-mainz.de
Insights
Laparoscopic inguinal hernia repair in children is a safe and effective outpatient procedure. This method offers clear visualization and comparable outcomes to open surgery, with easier management of recurrences.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Inguinal hernias are common in children.
- Traditional open repair has known complication rates.
- Laparoscopic techniques offer potential advantages in visualization and recovery.
Purpose of the Study:
- To prospectively evaluate the outcomes of laparoscopic inguinal hernia repair in a consecutive series of children.
- To compare the results with established open surgical procedures.
- To assess the safety, efficacy, and recurrence rates of the laparoscopic approach.
Main Methods:
- A series of 712 inguinal hernias were repaired laparoscopically in 542 children.
- Internal inguinal ring closure was performed using a 4-0 nonabsorbable suture.
- Patients were prospectively video-documented for analysis.
Main Results:
- No serious intraoperative complications were reported.
- Operating time was comparable to open surgery.
- Recurrence rates were 4.1%, with excellent cosmetic results and minimal complications like hydroceles or testicular atrophy.
Conclusions:
- Laparoscopic inguinal hernia repair is a viable routine procedure for children.
- The technique provides clear visualization, defect-specific closure, and leaves cord structures untouched.
- It is well-suited for managing recurrent hernias and offers advantages such as being an outpatient procedure.
Purpose:
This series prospectively evaluates a consecutive personal series of children undergoing laparoscopic hernia repair.
Methods:
A total of 712 inguinal hernias were corrected laparoscopically in 542 children (396 boys and 146 girls, aged 4 days to 14 years, median 1.6 years). The internal inguinal ring was closed with a 4-0 nonabsorbable suture using 2-mm instruments. Patients were prospectively video-documented.
Results:
There were no serious intraoperative complications. Operating time was comparable to open surgery. The contralateral inner ring was open on the left side in 16% of boys and 12% of girls, and on the right side in 18% of boys and 32% of girls. Direct hernias were found in 2.3%, femoral hernias in 1%, hernias en pantalon in 0.7%, and a combination of indirect and femoral hernia in 0.2%. Follow-up to date is 1-84 months (median 39 months). There were 4.1% hernia recurrences, 0.7% hydroceles and 0.2% testicular atrophies. Cosmesis is excellent.
Conclusions:
Laparoscopic inguinal hernia repair can be a routine procedure with results comparable to those of open procedures. It is well suited for recurrences. The vas remains untouched. The visualization of structures is clear and leads to a defect-specific closure. The advantages of the laparoscopic approach include the following: its technical ease, it is an outpatient procedure, the cord structures remain untouched, the type of hernia is obvious, trocar placement is identical for any side or hernia type, clear visualization of the anatomy. Routine video documentation renders the diagnostic accuracy objective and absolute. Finally, recurrences are easier dealt with, be it from a previous open or from a laparoscopic approach. Although recurrences were slightly more frequent in the early stages, now they are closer to the rate with the open procedure.
