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[Laparoscopic inguinal herniorrhaphy in children--experiences in a primary medical care center]
C Classen1, D Palmes, R Horstmann
1Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Zentrum für Minimal-Invasive Chirurgie, Herz-Jesu-Krankenhaus Münster.
Insights
Laparoscopic herniorrhaphy is a safe and effective minimally invasive surgery for children. This study shows it has low complication rates and comparable costs to open surgery for groin hernias.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Hernia repair
Background:
- Laparoscopic herniorrhaphy offers potential benefits for children, including minimally invasive access and contralateral groin exploration.
- This study reports on the feasibility and outcomes of introducing this technique in a tertiary care setting.
Purpose of the Study:
- To evaluate the safety, efficacy, and feasibility of laparoscopic herniorrhaphy in children.
- To assess intra- and postoperative complications, recurrence rates, and economic aspects of the procedure.
Main Methods:
- A prospective study of 50 laparoscopic herniorrhaphies in 44 children (17 months–11 years) between 2001 and 2007.
- Laparoscopic access via transumbilical insertion of a 5-mm laparoscope and two 2-mm needle holders.
- Inguinal ring closure using resorbable or non-absorbable sutures, with follow-up for complications and recurrence.
Main Results:
- No intra- or perioperative complications were observed.
- Median operation time was 19 minutes, with 98% of cases performed on an outpatient basis.
- Two recurrences (4.5%) occurred within 6 months in children treated with absorbable sutures; costs were comparable to open repair.
Conclusions:
- Laparoscopic herniorrhaphy is a safe and effective surgical option for pediatric groin hernias.
- The procedure is recommended for tertiary referral centers with expertise in minimally invasive techniques.
- Non-absorbable sutures may be preferred for inguinal ring closure to minimize recurrence rates.
Aim:
Children undergoing laparoscopic herniorrhaphy may benefit from a minimally invasive access and the possible exploration of the contralateral groin. In this prospective feasibility study, the experiences and results after introduction of this method in a tertiary referral medical center are reported.
Methods:
50 laparoscopic herniorrhaphies were performed in 44 children (32 boys and 12 girls, range: 17 months-11 years) with open inner inguinal rings between January 2001 and March 2007. In 6 children (13.6 %) an additional contralateral open inner inguinal ring was detected. Laparoscopic access was obtained with a 5-mm laparoscope which was inserted transumbilically and two 2-mm needle holders were inserted through the inferolateral abdominal wall. The open inner inguinal rings were closed in 8 children using a resorbable Z-suture and in 36 children using a monofilamentous non-absorbable suture. Follow-up examinations included records of intra- and postoperative complications, recurrence rate and economic aspects.
Results:
No intra- or perioperative complications occurred. Median operation time was 19 minutes. 43 / 44 operations were carried on an outpatient basis. Average material costs were about 20 Euro without any difference from the open access. During 36 months the follow-up rate was 91 %. Two children who had previously received an absorbable suture suffered from a recurring groin hernia within the first 6 months.
Conclusion:
Laparoscopic herniorrhaphy in children represents a safe and effective surgical method that can be recommended for tertiary referral medical centers with training facilities and experience in minimally invasive surgery.