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[Laparoscopic treatment of congenital inguinal hernias in children (212 patients)]
F Becmeur1, C Dimitriu, I Lacreuse
1Service de chirurgie infantile, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 67098 Strasbourg cedex, France. francois.becmeur@chru-strasbourg.fr
Insights
Laparoscopic surgery for pediatric inguinal hernias offers significant advantages, including the detection of undiagnosed hernias and improved outcomes in recurrent cases. This minimally invasive approach provides precise diagnosis and atraumatic dissection, enhancing patient care.
Area of Science:
- Minimally invasive surgery
- Pediatric surgery
- Hernia repair
Context:
- Inguinal hernia repair in children is a common procedure.
- Laparoscopic techniques are increasingly explored as alternatives to traditional open surgery.
- The efficacy and benefits of laparoscopy for pediatric inguinal hernias require further elucidation.
Purpose:
- To evaluate the results and advantages of laparoscopic treatment for inguinal hernias in children.
- To assess the diagnostic capabilities of laparoscopy in identifying contralateral, direct, and femoral hernias.
- To analyze the recurrence rates and benefits of laparoscopy in managing recurrent inguinal hernias.
Summary:
- Laparoscopy identified 26 previously undiagnosed contralateral hernias, along with direct, femoral, and other rare hernia types.
- The technique proved valuable in evaluating anatomical lesions in cases of recurrence after open inguinal repair, with only one recurrence observed.
- Dissection of the entire hernia sac is preferred to minimize recurrence, especially in children over two years old.
Impact:
- Laparoscopy offers precise diagnosis and identification of occult hernias, potentially reducing the need for repeat surgeries.
- The atraumatic dissection of spermatic vessels and vas deferens enhances safety during repair.
- Laparoscopic approach provides clear advantages in managing bilateral hernias and complex cases, improving surgical outcomes in pediatric patients.
Objectives:
Laparoscopic treatment of inguinal hernias in children remains controversial. The inguinal approach is the only recommended procedure nowadays. The aim of our series was to precise the results of this technique and its advantages.
Population And Methods:
We report our preliminary experience in laparoscopy for inguinal hernias in 212 children.
Results:
Laparoscopy allowed us to discover 26 controlateral hernias not previously diagnosed, 3 direct hernias with 1 of them associated with a patent process vaginalis, 2 femoral hernias associated with a patent process vaginalis, 1 double pouch hernia and 1 volvulus of a cyst developed from a patent process vaginalis. In case of recurrence after an inguinal approach, laparoscopy seemed to be helpful to evaluate the anatomical lesion. We observed only 1 recurrence.
Discussion:
Indications for laparoscopy in case of inguinal hernia in children are reviewed and discussed in the literature. Laparoscopic diagnosis for a precise diagnosis is no more discussed. Various techniques were proposed in case of laparoscopic treatment of inguinal hernias in children: most of surgeons realized only a suture of the sac. We prefer to dissect all the sac in order to avoid any recurrence. Advantages of laparoscopic approach become more obvious after the age of 2 years when the opening of the parietal wall is required in case of an inguinal approach and when local anaesthesia is no more recommended. The opportunity to diagnose a bilateral hernia when non diagnosed before surgery or to discover a femoral or a direct hernia, or in case of recurrence after an inguinal approach, the atraumatic dissection of the vas and spermatic vessels at the level of the internal inguinal ring, are the main advantages for laparoscopy.