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Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open?
S A Nah1, L Giacomello, S Eaton
1UCL Institute of Child Health & Great Ormond Street Hospital for Children, Unit of Paediatric Surgery, London, United Kingdom.
Insights
Open repair of incarcerated inguinal hernia in children led to serious complications. Laparoscopic repair is a safe alternative, reducing complications and allowing contralateral patent processus vaginalis repair.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Incarcerated inguinal hernia (IIH) in children presents management challenges.
- IIH can be associated with significant complications.
- Surgical repair is the definitive treatment for IIH.
Purpose of the Study:
- To compare the outcomes of laparoscopic versus open surgical repair for incarcerated inguinal hernia in children.
- To evaluate complication rates and other relevant outcomes between the two surgical approaches.
Main Methods:
- Retrospective review of 63 children diagnosed with IIH between 2000 and 2008.
- Data collected included patient demographics, surgical approach (open or laparoscopic), operative details, and postoperative outcomes.
- Statistical analysis using chi-squared or t-tests to compare groups.
Main Results:
- Open repair (n=35) involved 2 children requiring small bowel resection and 5 serious complications (vas transaction, undescended testis, testicular atrophy, recurrence).
- Laparoscopic repair (n=28) had a single recurrence and identified contralateral patent processus vaginalis in 54% of cases, which were repaired.
- Operative duration was longer in the laparoscopic group, but time to full feeds and hospital stay were similar.
Conclusions:
- Open repair of IIH in children is linked to a higher incidence of serious complications.
- Laparoscopic repair is a safe and effective technique for IIH.
- Laparoscopic approach facilitates inspection of hernia contents and repair of contralateral patent processus vaginalis.
Purpose:
The management of Incarcerated Inguinal Hernia (IIH) in children is challenging and may be associated with complications. We aimed to compare the outcomes of laparoscopic vs. open repair of IIH.
Methods:
With institutional ethical approval (09SG13), we reviewed the notes of 63 consecutive children who were admitted to a single hospital with the diagnosis of IIH between 2000 and 2008. Data are reported as median (range). Groups were compared by chi-squared or t-tests as appropriate.
Results:
· Open repair (n=35): There were 21 children with right and 14 with left IIH. 2 patients also had contralateral reducible inguinal hernia. Small bowel resection was required in 2 children. · Laparoscopic repair (n=28): All children had unilateral IIH (19 right sided, 9 left sided). 15 children (54%) with no clinical evidence of contralateral hernia, had contralateral patent processus vaginalis at laparoscopy, which was also repaired. The groups were similar with regard to gender, age at surgery, history of prematurity, interval between admission and surgery, and proportion of patients with successful preoperative manual reduction. However, the duration of operation was longer in the laparoscopy group (p=0.01). Time to full feeds and length of hospital stay were similar in both groups. Postoperative follow-up was 3.5 months (1-36), which was similar in both groups. 5 patients in the group undergoing open repair had serious complications: 1 vas transaction, 1 acquired undescended testis, 2 testicular atrophy and 1 recurrence. The laparoscopic group had a single recurrence.
Conclusion:
Open repair of incarcerated inguinal hernia is associated with serious complications. The laparoscopic technique appears safe, avoids the difficult dissection of an oedematous sac in the groin, allows inspection of the reduced hernia content and permits the repair of a contralateral patent processus vaginalis if present.