Preliminary experience of one-trocar laparoscopic herniorrhaphy in infants and children

Laparoscopy is an alternative procedure for pediatric inguinal hernia, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports. The aim of this study was to evaluate the preliminary results of one-trocar laparoscopic herniorrhaphy in infants and children.

Between April 2007 and March 2010, 216 infants and children treated were retrospectively reviewed. Under laparoscopic guidance, the hernia defect was closed extracorporeally by a nonabsorbable suture, which was introduced into the abdomen by an 18-gauge vascular access on one side of the hernia defect and withdrawn on the opposite side by a homemade hook-pin through a stab incision. Preperitoneal hydrodissection was performed during the procedure. Being a developing technique, multiple linear regressions were used to model markers for the operating time, including descriptive data, diameter of scope, operation findings, and the procedural volume.

A total of 308 procedures were successfully performed among 214 patients (99.1%) and the mean operating time was 42.9 ± 24.7 minutes (range: 9-255 minutes). Additional working instruments were necessary in 7 patients (3.3%). Only 2 (0.9%) recurrences were observed during this period. Male gender (β = 7.507, P = .001), prematurity (β = 10.051, P = .004), presence of incarcerated hernia (β = 12.188, P = .016), and both sides simultaneous operation (β = 7.057, P = .001) would increase the operating time, while being independent of age, weight, presence of sliding hernia, and diameter of scope. However, the operating time may decrease with procedural volume (β = -0.119, P < .001).

Without assistant working instrument, laparoscopy-assisted extracorporeal ligation of the hernia defect may be safely performed in most infants and children. The use of preperitoneal hydrodissection and extraperitoneal knot-tying could tautly enclose the hernia defect without peritoneal gaps and approach an accepted recurrence rate.