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Laparoscopic inguinal hernia repair in the pediatric age group--experience with 437 children
Sandesh V Parelkar1, Sanjay Oak, Rahul Gupta
1Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India. sandeshparelkar@kem.edu
Insights
Laparoscopic inguinal hernia repair in children is a safe and effective procedure with low recurrence rates and reduced morbidity compared to open surgery. This technique offers better cosmetic outcomes and minimizes risks like metachronous hernia and testicular atrophy.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- Inguinal hernias are common in children.
- Traditional open herniotomy carries risks.
- Laparoscopic techniques offer potential advantages.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic inguinal hernia repair in pediatric patients.
- To assess the safety and efficacy of this minimally invasive approach.
Main Methods:
- Retrospective analysis of prospectively collected data from 576 laparoscopic internal ring closures in 437 children (30 days-11 years).
- Internal ring closure using a 3-0 nonabsorbable suture with extracorporeal or intracorporeal knotting.
- Follow-up at 1 week and 6 weeks postoperatively, with extended follow-up to 108 months.
Main Results:
- A contralateral patent processus vaginalis was found in 6-15% of patients.
- Overall recurrence rate was 2.4% (14/576), with 0.35% hydrocele formation.
- Mean operative time was 23 minutes (unilateral) and 29 minutes (bilateral).
- No cases of metachronous hernia or testicular atrophy were observed.
Conclusions:
- Laparoscopic inguinal hernia repair is technically simpler and reduces the risk of metachronous hernia.
- The procedure offers better cosmetic results and less morbidity than open herniotomy.
- Laparoscopic repair is a viable routine procedure for pediatric inguinal hernias.
Background/Purpose:
A retrospective analysis of prospectively collected data of pediatric patients that underwent laparoscopic inguinal hernia repair.
Material And Methods:
A retrospective review was performed of the prospectively collected data of 576 laparoscopic internal ring closures in 437 children (age, 30 days-11 years; median, 1.9 years) from June 1999 to February 2009. The internal ring was closed with a 3-0 nonabsorbable suture. Both extracorporeal and intracorporeal methods of knotting were used. All patients were asked to return at 1 week and 6 weeks postoperatively for routine follow-up.
Results:
A contralateral patent processus vaginalis was present in 13% (45/352) of boys and 15% (12/83) of girls on the right side, and 7% (25/352) of boys and 6% (5/83) of girls on the left side. Follow-up range was from 1 week postoperatively to 108 months. There were 14 recurrences (2.4 % [14/576], 11 in boys and on the right side and 3 in girls) and 2 hydroceles 0.35% (2/576). Mean operating time was 23 minutes for unilateral and 29 minutes for bilateral inguinal hernia. There was neither metachronus hernia nor testicular atrophy observed during follow-up.
Conclusion:
Laparoscopic inguinal hernia repair is technically easier, as there is no need to dissect the vas deferens and vessels. The risk of metachronous hernia is reduced, and we believe the cosmetic result is better. Although recurrences were more common early in the series, currently they are much less frequent. Laparoscopic inguinal hernia repair appears to have less morbidity than open herniotomy and can be used as routine procedure in the pediatric age group.
