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Minimal access surgery of pediatric inguinal hernias: a review
Ramanathan Saranga Bharathi1, Manu Arora, Vasudevan Baskaran
1Department of Surgery, Armed Forces Medical College, Pune, Maharashtra, 411040, India. sarangabharathi@rediffmail.com
Insights
Laparoscopic surgery is becoming the preferred method for pediatric inguinal hernias (PIH), offering precise detection and simultaneous repair. Emerging techniques favor wider adoption of minimally invasive approaches for PIH treatment.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Laparoscopy
Background:
- Inguinal hernia is a common pediatric condition.
- Herniotomy is the standard treatment.
- Laparoscopy offers advantages in diagnosis and repair.
Purpose of the Study:
- To review laparoscopic techniques for pediatric inguinal hernia (PIH).
- To discuss the evolution and advantages of minimally invasive surgery for PIH.
- To highlight emerging trends in laparoscopic PIH repair.
Main Methods:
- Comprehensive review of laparoscopic techniques for PIH.
- Analysis of variations in approaches, port usage, instruments, sutures, and knotting.
- Discussion of factors influencing technique selection.
Main Results:
- Laparoscopy precisely detects contralateral patencies, reducing routine exploration.
- It allows simultaneous repair of various hernia types and contralateral patencies.
- Emerging techniques favor extracorporeal knotting and reduced instrument use.
Conclusions:
- Laparoscopic surgery is a viable alternative to conventional repair for PIH.
- Minimal access surgery is trending towards becoming the gold standard for PIH.
- Technological advancements facilitate wider adoption of laparoscopic PIH repair.
Abstract:
Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons' experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.
