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Technical standardization of laparoscopic direct hernia repair in pediatric patients
Ciro Esposito1, Francesca Alicchio, Ida Giurin
1Department of Pediatrics, Federico II University of Naples, Naples, Italy. ciroespo@unina.it
Insights
Laparoscopic repair of direct inguinal hernias in children is safe and effective. This technique standardizes treatment for pediatric inguinal hernias, especially recurrent cases, with no complications or recurrences observed.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Direct inguinal hernias are uncommon in children.
- Recurrent inguinal hernias often require advanced surgical techniques.
Purpose of the Study:
- To standardize a laparoscopic technique for treating direct inguinal hernias in pediatric patients.
- To evaluate the safety and efficacy of this standardized laparoscopic approach.
Main Methods:
- Laparoscopic treatment of 7 pediatric patients with direct inguinal hernias.
- Use of 5-mm optic and two 3-mm instruments.
- Resection of lipoma, defect closure with nonabsorbable sutures, and reinforcement with the vesical ligament.
Main Results:
- Average operative time of 35 minutes.
- All procedures performed in a day-hospital setting.
- No conversions or complications; zero recurrence rate after a minimum 1-year follow-up.
Conclusions:
- Laparoscopic repair is a safe and effective method for pediatric direct inguinal hernias.
- Key technique elements include lipoma resection, secure suture closure, and vesical ligament reinforcement.
- Laparoscopy is the gold standard for diagnosing and treating recurrent inguinal hernias after open repair.
Background:
The aim of this article is to standardize the laparoscopic technique to treat direct inguinal hernia in pediatric patients.
Patients And Methods:
In the last 3 years we treated laparoscopically 163 patients with a diagnosis of inguinal hernia. In 7 patients we discovered laparoscopically a direct inguinal hernia. This study is focused on the management of these 7 cases (4 girls and 3 boys; median age 4.6 years). They presented a right defect in 4 cases and a left defect in 3 cases. Six of 7 patients had been already operated for an inguinal hernia and presented a recurrence of the hernia. We used three trocars, 5-mm 0 degree optic, and two 3-mm instruments. In each case, after the resection of the lipoma using the hook cautery, the defect was closed by means of separated stitches. In every case we used the vesical ligament as an autologous patch to reinforce the closure of the defect.
Results:
The average operative time was 35 minutes. All the procedures were performed in a day-hospital setting. We had neither conversions nor complications in our series. With a minimum follow-up of 1 year, we had no recurrence.
Conclusions:
Laparoscopic identification and repair of direct inguinal hernia in children is a safe and effective procedure to adopt. The key points of the technique are the resection of the lipoma, the closure of the defect using separated, nonabsorbable sutures, and the use of the vesical ligament to reinforce the suture. We believe that in case of recurrence of inguinal hernias after inguinal approach, laparoscopy is the gold standard technique to identify and treat the cause of the recurrence itself.
