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Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country
S M K Shehata1, A A El Attar, M A Attia
1Department of Pediatric Surgery, Tanta University Hospital, 12th El-Motawakel Street, Flat No.1, Tanta El-Gidida, Tanta, 31111, Egypt. sherifshehata2001@yahoo.com
Insights
Laparoscopic herniotomy is a safe and feasible procedure for pediatric inguinal hernias (PIH), even in resource-limited settings. This minimally invasive approach offers excellent visualization and reduces postoperative complications.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Pediatric inguinal hernia (PIH) is a common condition requiring surgical intervention.
- Assessing the feasibility of laparoscopic herniotomy (LH) in resource-limited tertiary centers is crucial for expanding access to advanced surgical techniques.
Purpose of the Study:
- To prospectively evaluate the feasibility and outcomes of laparoscopic herniotomy (LH) for pediatric inguinal hernia (PIH).
- To assess the safety and efficacy of LH in a tertiary center with limited resources.
Main Methods:
- A prospective study of 56 children with unilateral PIH over 18 months.
- All patients underwent LH, with exploration for contralateral patent processus vaginalis (CPPV) without sac ligation.
- Exclusion criteria included prematurity, age <6 months, irreducible/recurrent hernia, and large internal ring diameter.
Main Results:
- 56 children (6 months-15 years) with unilateral PIH were treated.
- Mean operative time was 20.5 min for unilateral and 42.5 min for bilateral cases; no conversions were reported.
- No recurrence, testicular atrophy, or hydrocele occurred during a mean 20.5-month follow-up; two cases of wound infection were managed conservatively.
Conclusions:
- Laparoscopic herniotomy is a feasible and safe surgical option for pediatric inguinal hernias.
- LH provides superior visualization of cord structures and aids in diagnosing CPPV and rare hernias, allowing simultaneous management.
- The procedure demonstrates minimal postoperative complications, making it suitable for developing countries.
Purpose:
We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources.
Methods:
Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed.
Results:
We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months.
Conclusions:
Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.
