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Laparoscopic flip-flap technique versus conventional inguinal hernia repair in children
Mohamed E Hassan1, A R Mustafawi
1Pediatric Surgery Department, Alwasl Hospital, Dubai, United Arab Emirates. dmia88@hotmail.com
Insights
The laparoscopic flip-flap technique for pediatric inguinal hernia repair showed poor outcomes, with higher complication and recurrence rates compared to conventional open repair. Open repair remains the preferred method for children.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Inguinal hernia repair is a common pediatric surgical procedure.
- Laparoscopic techniques for pediatric inguinal hernia repair are emerging but their efficacy is debated.
- The feasibility of laparoscopy for treating pediatric inguinal hernias remains unresolved.
Purpose of the Study:
- To evaluate the outcomes of a new laparoscopic flip-flap technique for pediatric inguinal hernia repair.
- To compare the new laparoscopic technique with conventional open repair in children.
Main Methods:
- A retrospective cohort study compared 33 pediatric patients undergoing inguinal hernia repair.
- Patients were divided into two groups: laparoscopic flip-flap repair (Group A, n=15) and conventional open repair (Group B, n=18).
Main Results:
- The laparoscopic group had a longer operative time (47.5 min vs 27.5 min) and higher intraoperative complication rates (7% vas deferens injury, 20% flap tears).
- Postoperative recurrence rates were significantly higher in the laparoscopic group (27%) compared to the open repair group (0%).
- Mean postoperative hospital stay was similar (5.5 hours) for both groups.
Conclusions:
- The preliminary results indicate unsatisfactory outcomes with the laparoscopic flip-flap technique in pediatric inguinal hernia repair.
- Conventional open repair is considered the gold standard for pediatric inguinal hernias based on this experience.
- Further studies with larger patient numbers and long-term follow-up are recommended.
Background And Objectives:
Inguinal hernia repair is one of the most frequently performed pediatric surgical operations. Several pediatric laparoscopic inguinal hernia repair techniques have been introduced. But debate is unresolved regarding the feasibility of laparoscopy for treating pediatric inguinal hernias.
Methods:
A retrospective cohort study enrolled 33 patients who underwent congenital inguinal hernia repair by either the new laparoscopic flip-flap technique or conventional open repair. Patients were divided into 2 groups according to the type of surgery: Group A included those who underwent the new laparoscopic technique, and Group B included those who underwent conventional open repair.
Results:
Group A comprised 15 patients (mean age, 39 months), and group B comprised 18 (mean age, 44 months). Mean operative time was 47.5 minutes for Group A versus 27.5 minutes for Group B. Intraoperative complications for Group A included 1 case (7%) of vas deferens injury, and 3 cases (20%) in which the flaps were torn during suturing. In Group B, no intraoperative complications were encountered. In both groups, the mean postoperative hospital stay was 5.5 hours. Postoperative follow-up of 3 months revealed recurrence in 4 patients in Group A (27%), while there were no recurrences in Group B.
Conclusion:
Our preliminary experience shows unsatisfactory outcomes with laparoscopic flip-flap hernia repair in children. In spite of advancement in the application of laparoscopy in pediatric surgery, conventional open hernia repair is still the gold standard for children, in our experience. Future studies with more numbers and longterm follow-up should be conducted.