Technical standardization of laparoscopic herniorraphy in pediatric patients
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Ciro Esposito1, Leonardo Montinaro, Francesca Alicchio
1Department of Pediatrics, Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it
Insights
Laparoscopic inguinal hernia repair in children is safe and effective, with low recurrence rates. This technique allows simultaneous repair of bilateral hernias and contralateral patencies, offering an alternative to traditional surgery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic inguinal hernia repair is infrequently documented in pediatric populations.
- This study details a standardized laparoscopic technique for pediatric inguinal hernia repair.
Purpose of the Study:
- To demonstrate the standardization and efficacy of laparoscopic inguinal hernia repair in pediatric patients.
- To present surgical outcomes and complication rates for this minimally invasive approach.
Main Methods:
- A 3-year study involving 315 pediatric patients undergoing laparoscopic unilateral inguinal hernia repair.
- Utilized a modified laparoscopic herniorraphy technique with three trocars.
- Closed the periorificial peritoneum with a nonresorbable purse-string suture.
Main Results:
- Average operating time was 25 minutes; all procedures were outpatient.
- Contralateral patent processus vaginalis found in 39% of cases, leading to bilateral repair.
- Low complication rate (0.3%) and recurrence rate (0.6%) observed with a minimum 1-year follow-up.
Conclusions:
- Laparoscopic inguinal hernia repair is a safe and effective option for pediatric patients when performed by experienced surgeons.
- The technique facilitates simultaneous repair of all hernia types, including contralateral patencies.
- Established as a viable alternative to conventional open hernia repair methods.
Background:
Laparoscopic inguinal hernia repair is rarely reported in pediatric patients. We report our experience on this topic to show the standardization of the technique.
Methods:
In a 3-year period we operated 315 patients for unilateral inguinal hernia using laparoscopy. Fifty of the 315 patients (15.9%) were younger than 1 year old. The age ranged from 1 month to 8 years (median 3.2) with a median body weight of 14.3 kg. We always used three trocars, and we used the modified laparoscopic herniorraphy according to Montupet. After sectioning the sac distally to the ring, the periorificial peritoneum was closed with a purse-string suture of nonresorbable suture material.
Results:
The operating time averaged 25 min. All the procedures were performed in a day-hospital setting. In 123/315 patients (39%), at operation we found a contralateral patency of the processus vaginalis. In these 123 cases we performed a bilateral herniorraphy. In one girl (0.3%) we found a coexistence of oblique external hernia and a direct hernia, and both orifices were sutured in laparoscopy. We recorded only 1 minor complication: a problem with needle extraction. With a minimum follow-up of 1 year, there were 2 recurrences (0.6%).
Conclusions:
We believe that laparoscopic repair of inguinal hernia in expert hands is a safe and effective procedure. It makes it possible to repair all forms of inguinal hernia simultaneously, together with contralateral patencies, which has cemented its role as an alternative to conventional repair.
