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[Laparoscopic inguinal hernia repair in infants]
Dan Arbell1, Boris Orkin, Raphael Udassin
1Department of Pediatric Surgery, Hadassah-Hebrew University Hospital, Jerusalem, Israel. arbell@hadassah.org.il
Insights
Transabdominal laparoscopic hernia repair is a feasible approach for infants younger than six months. This method showed a high incidence of occult bilateral hernias, suggesting its suitability for this age group.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Laparoscopic procedures
Context:
- Contralateral pediatric inguinal hernia treatment remains controversial.
- Occult bilateral hernias are more common in infants under 6 months.
- Laparoscopic manipulation of hernia sacs can be challenging in young infants.
Purpose:
- To evaluate the feasibility and early outcomes of transabdominal laparoscopic hernia repair in infants under 6 months.
- To assess the incidence of occult bilateral hernias in this age group using a transabdominal laparoscopic approach.
Summary:
- Thirty-four infants under 6 months with unilateral inguinal hernia underwent transabdominal laparoscopic repair.
- The procedure was successfully completed laparoscopically in 33 cases.
- An incidence of 38.2% for occult bilateral hernias was observed.
- Recurrence rates and complications were documented, with 3 recurrences (6.4%) and minor operative/anesthetic issues.
Impact:
- Transabdominal laparoscopic repair is a viable option for pediatric inguinal hernias in infants under 6 months.
- This technique may be particularly advantageous for managing potential bilateral hernias in this population.
- Further research is necessary to determine the long-term efficacy and safety of this approach.
Background:
The approach for treating contralateral pediatric inguinal hernias is still controversial. The options are delaying surgery on the contralateral side, automatic exploration, diagnostic laparoscopy through the ipsilateral hernia sac or laparoscopic repair. In children younger than 6 months, occult bilateral hernia is more prevalent, and the hernia sac is difficult for laparoscopic manipulation. We present our early experience with transabdominal laparoscopic hernia repair in infants younger than 6 months of age.
Methods:
Thirty four infants younger than 6 months and presenting with unilateral inguinal hernia were operated laparoscopically through a transabdominal approach. Patients were followed for a median of 11 months.
Results:
Thirty three of the operations were completed laparoscopically. There was a 38.2% incidence of occult bilateral hernia. There were 3 recurrences due to a technical mistake (6.4%), one minor operative complication (needle lost and retrieved) and one minor anesthetic complication (prolonged intubation). In one operation a mini laparotomy was performed to retrieve a needle that was disengaged whilst removed from the abdomen.
Conclusions:
Laparoscopic hernia repair is feasible in young infants. It may be particularly suitable for children younger than 6 months. Further studies are needed to assess long-term results.