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Laparoscopic hernia repair in infancy and childhood: evaluation of 2 different techniques
Rafik Shalaby1, Maged Ismail, Ahmad Dorgham
1Pediatric Surgery Unit, Al-Azhar University Hospitals, Nasr City, 11884, Cairo, Egypt. rafikshalaby@hotmail.com
Insights
Extracorporeal knotting using a Reverdin needle (RN) is an effective laparoscopic technique for pediatric inguinal hernia repair. This method significantly reduces operative time and improves cosmetic outcomes with low recurrence rates compared to intracorporeal suturing.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Laparoscopic hernia repair in children remains a subject of debate with various techniques available.
- Comparing intracorporeal versus extracorporeal knotting is crucial for optimizing outcomes.
Purpose of the Study:
- To compare intracorporeal suturing and knotting with extracorporeal knotting for congenital inguinal hernia repair in pediatric patients.
- To evaluate operative time, recurrence rate, hydrocele formation, and cosmetic results.
Main Methods:
- A randomized controlled study involving 150 infants and children with congenital inguinal hernia.
- Group A: Intracorporeal purse string suture. Group B: Extracorporeal knotting using a Reverdin needle (RN).
- Outcomes measured included operative time, hospital stay, hydrocele formation, recurrence, and cosmetic results.
Main Results:
- No significant differences in age, sex, or presentation between groups.
- Significant reductions in operative time and improved cosmetic results were observed with the Reverdin needle (RN) technique.
- No significant differences in hospital stay or postoperative hydrocele formation were found.
Conclusions:
- Laparoscopic hernia repair using a Reverdin needle (RN) is effective in infants and children.
- This technique offers reduced operative time, excellent cosmetic results, and low recurrence rates.
- Extracorporeal knotting with RN is a viable and advantageous method for pediatric inguinal hernia repair.
Purpose:
Laparoscopic hernia repair in infancy and childhood is still debatable. There are many techniques available for laparoscopic hernia repair in children. The objective of this study was to compare intracorporeal suturing and knotting with extracorporeal knotting for repair of congenital inguinal hernia in infants and children about operative time, recurrence rate, hydrocele formation, and postoperative cosmetic results. A randomized controlled study was carried out in the Pediatric Surgery Unit of Al-Azhar University Hospitals (Cairo, Egypt) over a 3-year period.
Patients And Methods:
One hundred fifty patients with congenital inguinal hernia were randomized into 2 equal groups (n = 75). Group A was subjected to intracorporeal purse string suture around the internal inguinal ring (IIR) using 2 needle holders. Group B was subjected to insertion of purse string suture around IIR using a Reverdin needle (RN) and extracorporeal knotting. Inclusion criteria included bilateral inguinal hernia, recurrent hernia, hernia in obese children, incarcerated hernia, and ipsilateral hernia with questionable hernia on the contralateral side. Exclusion criteria included unilateral inguinal hernia and hernia with undescended testicles. The main outcome measurements were operative time, length of hospital stay, postoperative hydrocele formation, recurrence rate, and cosmetic results.
Results:
There were no significant differences about age, sex, and mode of presentation between both groups. All cases were completed successfully without conversion. There were significant statistical differences in the operative time, recurrence rate, and cosmetic results between the studied groups, whereas there were no significant statistical differences in the hospital stay and postoperative hydrocele formation.
Conclusion:
Laparoscopic hernia repair by RN is an effective method of hernia repair in infants and children. It resulted in a marked reduction of operative time and excellent cosmetic results with low recurrence.
