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Single port laparoscopic repair of paediatric inguinal hernias: Our experience at a secondary care centre
Ameet Kumar1, T S Ramakrishnan
1Department of Surgery, Air Force Hospital, Kanpur Cantt, Uttar Pradesh, India.
Insights
Single port laparoscopic inguinal hernia repair is safe and effective in children, even in secondary hospitals. This minimally invasive technique offers benefits with fewer resources and complications.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Laparoscopic Techniques
Background:
- Congenital inguinal hernias are a common pediatric surgical issue, with herniotomy as the standard treatment.
- Minimally invasive surgery (MIS) has evolved, with single-port techniques emerging as a less invasive option.
- Previous single-port studies originated from tertiary care centers.
Purpose of the Study:
- To evaluate the clinical outcomes of a novel single-port laparoscopic inguinal hernia repair technique.
- To assess the feasibility of this modified technique in a secondary level hospital setting.
- To compare outcomes with conventional open surgery and other MIS approaches.
Main Methods:
- Prospective review of 37 laparoscopic inguinal hernia repairs in 31 children (8 months - 13 years).
- A modified single-port technique involving extraperitoneal encirclement of the internal ring with non-absorbable suture.
- Data collected included operative time, complication rates, occult contralateral patent processus vaginalis (PPV) detection, and cosmesis.
Main Results:
- Operative times averaged 13.20 minutes for unilateral and 20.66 minutes for bilateral repairs.
- Contralateral PPV was identified and repaired in 16.66% of cases (all left-sided hernias).
- Low complication rates: 2.7% recurrence, 2.7% postoperative hydrocele, and one case requiring an additional port.
Conclusions:
- Single-port laparoscopic inguinal hernia repair is a safe and feasible option for pediatric patients.
- This technique extends the benefits of MIS to secondary care centers with limited resources.
- The technique's minimal instrumentation and avoidance of intracorporeal knotting enhance its applicability.
Background:
Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive - from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital.
Materials And Methods:
Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis.
Results:
Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8-25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries.
Conclusion:
Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre.
