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Laparoscopic inguinal hernia repair in premature neonates: is it safe?
I H Y Chan1, C T Lau, P H Y Chung
1Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China. ivyhychan@gmail.com
Insights
Laparoscopic inguinal hernia repair is safe for premature infants once they reach a suitable weight. Waiting to repair allows for better outcomes and reduces risks like incarceration and postoperative apnea.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Minimally Invasive Surgery
Background:
- Advances in neonatal care have improved survival rates for premature infants.
- Inguinal hernias are common in premature neonates, but optimal repair timing is unclear.
- Laparoscopic repair offers potential benefits for this population.
Purpose of the Study:
- To review the outcomes of laparoscopic inguinal hernia repair in premature infants.
- To evaluate the safety, feasibility, and risks associated with this approach.
- To determine the optimal timing for repair based on body weight.
Main Methods:
- Retrospective review of 79 premature neonates undergoing laparoscopic inguinal hernia repair (2001-2011).
- Repair was offered at 2.5 kg body weight unless contraindicated.
- Data collected included operative results, complications, incarceration, and postoperative apnea.
Main Results:
- Mean gestational age at birth was 31.9 weeks; at operation, 46.5 weeks.
- One case of incarceration required emergency surgery; one recurrence (1.3%).
- No postoperative apnea was observed.
Conclusions:
- Laparoscopic inguinal hernia repair is safe and feasible in premature neonates with adequate anesthesia support.
- Delaying repair until a reasonable body weight is achieved is beneficial.
- Low risk of incarceration supports a waiting strategy for laparoscopic repair.
Objective:
With advances in clinical medicine, many premature babies nowadays can have excellent survival outcomes. As the incidence of inguinal hernias in this group is high and there is scarce data in the literature regarding the optimal timing for repair, this study aims to review our experience in laparoscopic repair in premature infants.
Methods:
In our centre, premature neonates with inguinal hernia noted during hospitalization were offered laparoscopic repair when the body weights reached 2.5 kg unless there is contraindication for laparoscopy. A retrospective review was carried out for all premature neonates who underwent laparoscopic inguinal hernia repair from 2001 to 2011. The operative results, complications, incarceration risk and postoperative apnea risk were recorded.
Result:
A total of 79 premature neonates received laparoscopic inguinal hernia repair during this period. The mean gestational age at birth was 31.9 weeks (27-36 weeks) and the mean gestational age at operation was 46.5 weeks (33-92 weeks). One patient had incarceration and required emergency operation while waiting for the elective repair. The mean operative time was 44.9 min (25-93 min). One patient (1.3 %) had recurrence. No postoperative apnea was noted in any patient.
Conclusion:
Laparoscopic hernia repair is safe and feasible in premature neonates when they attain reasonable body size, as long as there is excellent anaesthesia support. Low risk of incarceration was noted in this study and it is worth waiting for the body weight to build up and hence facilitate laparoscopic repair.
