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Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated
Kin Wai Edwin Chan1, Kim Hung Lee, Yuk Him Tam
1Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. edwinchan@surgery.cuhk.edu.hk
Insights
Emergency laparoscopic inguinal hernia repair using the hook method is safe and effective in children. This technique facilitates easier dissection and leads to successful outcomes with no recurrence.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic hernia repair offers an alternative to open surgery for pediatric incarcerated inguinal hernias.
- Various laparoscopic techniques exist, but the hook method in emergencies is reviewed here.
Purpose of the Study:
- To review the efficacy of the laparoscopic hook method for emergency incarcerated inguinal hernia repair in children.
Main Methods:
- Retrospective review of pediatric patients undergoing emergency laparoscopic inguinal hernia repair with the hook method (2004-2010).
Main Results:
- 16 children (15 boys, 1 girl) underwent the procedure.
- Successful hernia reduction was achieved in all cases, with 37 minutes median operative time.
- No postoperative complications, recurrence, or testicular atrophy observed at median 40-month follow-up.
Conclusions:
- Emergency laparoscopic inguinal hernia repair using the hook method is safe and feasible in children.
- The technique simplifies preperitoneal dissection and allows simultaneous contralateral repair.
Background:
The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children.
Methods:
A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010.
Results:
There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy.
Conclusions:
Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting.