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Laparoscopic herniorrhaphy after manual reduction of incarcerated inguinal hernia
A Koivusalo1, M P Pakarinen, R J Rintala
1Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
Background:
After a manual reduction (MR) of an incarcerated inguinal hernia (IIH), it is recommended that an open herniotomy (OH) be performed after a one-day delay because of the postincarceration tissue edema. We assumed that performing laparoscopic herniorrhaphy (LH) shortly after MR reduces the hospital stay for IIH. We compared LH with OH retrospectively. We expected equal results but a shorter hospital stay with LH.
Methods:
From May 2002 to April 2006, 40 successive patients with IIH were admitted. OH was scheduled two days after MR, whereas no delay for performing LH was required. Patients in whom MR failed and who required immediate surgery (n = 4) and patients whose medical condition prevented surgery within the schedule (n = 3) were excluded from the study. Follow-up consisted of an outpatient visit and telephone survey.
Results:
Thirty-three patients (31 male, 15 OH, 18 LH) were included. For the LH patients, the median age was 15 (0.7-81) months and that for OH patients was 8.6 (0.6-61) months. For LH patients, weight = 11.5 (3.6-22) kg and for OH patients, weight = 9.8 (3.5-17) kg (p = NS). Median delay from MR to OH was 2 (2-4) days, and from MR to LH median delay was 1 (0-3) day (p < 0.05). Length of the operation was 29 (10-80) min in OH and 39 (20-60) min in LH (p = NS). Total theatre time was 44 (17-111) min in OH and 66 (44-86) min in LH (p < 0.05), and hospital time was 3 (3-6) days in OH and 2 (1-4) days in LH (p < 0.05). Median cost (surgery + hospitalization) of OH was euro 2315 (1910-3530) and that of LH was euro 3215 (2605-3650) (p < 0.05). Median follow-up was 26 (4-49) months, one patient (LH) had re-LH for recurrent hernia.
Conclusion:
After MR, LH can be performed with minimal delay and similar results as OH. Despite increased theatre time and total hospital costs, LH shortened hospital stay.
Insights
Laparoscopic herniorrhaphy (LH) performed shortly after manual reduction (MR) for incarcerated inguinal hernia (IIH) offers similar outcomes to open herniotomy (OH) but significantly reduces hospital stays.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Incarcerated inguinal hernia (IIH) typically requires open herniotomy (OH) after manual reduction (MR) due to post-reduction tissue edema.
- A delayed surgical approach is standard practice to mitigate potential complications.
Purpose of the Study:
- To evaluate if laparoscopic herniorrhaphy (LH) performed soon after MR for IIH can reduce hospital stay compared to OH.
- To compare the outcomes and efficiency of LH versus OH in pediatric patients with IIH.
Main Methods:
- A retrospective study compared 18 patients undergoing LH with 15 patients undergoing OH for IIH.
- Patients underwent MR, with OH scheduled two days post-MR and LH performed with minimal delay.
- Exclusion criteria included failed MR requiring immediate surgery and medical conditions precluding timely surgery.
Main Results:
- LH patients experienced a shorter median delay from MR (1 day) compared to OH patients (2 days).
- Hospital stay was significantly shorter for LH (2 days) versus OH (3 days).
- While LH incurred higher theatre time and total costs, it resulted in a shorter hospital stay.
Conclusions:
- Laparoscopic herniorrhaphy (LH) is a viable option for incarcerated inguinal hernia (IIH) following manual reduction (MR).
- LH can be performed with minimal delay, yielding comparable results to open herniotomy (OH).
- Despite increased costs, LH effectively shortens the hospital stay for IIH patients.
