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Laparoscopic management of recurrent inguinal hernia in childhood
Rafik Shalaby1, Maged Ismail1, Samir Gouda1
1Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
Insights
Laparoscopic repair of recurrent inguinal hernias in children is safe and effective, avoiding difficult redo surgery. This technique minimizes operative time and prevents recurrence, offering a favorable outcome for pediatric patients.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Hernia repair
Background:
- Open repair of recurrent inguinal hernias (RIH) in children presents challenges, including risks to vas deferens and testicular vessels.
- Laparoscopic repair of RIH offers an advantage by avoiding the previous operative site, reducing potential injury.
Purpose of the Study:
- To evaluate the experience and outcomes of laparoscopic repair for recurrent inguinal hernias in infants and children.
- To highlight technical refinements aimed at preventing recurrence after laparoscopic repair of RIH.
Main Methods:
- A retrospective review of 38 pediatric patients (42 recurrent defects) undergoing laparoscopic inguinal hernia repair (LIHR) for RIH.
- Primary outcomes included operative time and recurrence rate; secondary outcomes assessed complications, hydrocele formation, and testicular atrophy.
Main Results:
- All 42 laparoscopic procedures were completed successfully without conversion, intraoperative, or postoperative complications.
- Mean operative times were 15 minutes for unilateral and 20 minutes for bilateral cases.
- At a mean follow-up of 12.7 months, no recurrence or testicular atrophy was observed; two cases of hydrocele resolved with conservative management.
Conclusions:
- Laparoscopic repair of RIH in pediatric patients is an attractive option, circumventing the complexities of surgery in scarred fields.
- This minimally invasive approach effectively prevents recurrence and avoids injury to delicate structures, even after prior open or laparoscopic procedures.
Background:
Open repair of recurrent inguinal hernias [RIH] in infancy and childhood is difficult and there is definite risk of damaging the vas deferens and testicular vessels. Laparoscopic repair of RIH has the benefit of avoiding the previous operative site. The aim of this study is to present our experience with laparoscopic repair of RIH either after open or laparoscopic hernia repair with stress on technical refinements to prevent recurrence.
Patients And Methods:
This is a retrospective study of laparoscopic repair of RIH. Records of 38 patients with 42 recurrent hernial defects that have been subjected to laparoscopic inguinal hernia repair [LIHR] for RIH were reviewed and evaluated. The primary outcome measurements of this study include; operative time and recurrence rate. The secondary outcomes include intraoperative and postoperative complications, hydrocele formation and testicular atrophy.
Results:
In this study 38 children with 42 recurrent hernial defects [4 patients had bilateral recurrent hernia] were operated upon laparoscopically. They were 34 males and 4 females with a mean age of 2.54±1.989years (range=0.58-10.00years). In 35 hernial defects the recurrence developed after open herniotomy, while in 7 hernial defects it occurred after laparoscopic repair. All procedures were completed laparoscopically without any conversion and there were no intraoperative or postoperative complications during this study. Mean operating time was 15±2.3minutes for unilateral and 20±1.7minutes for bilateral inguinal hernia. All patients achieved full recovery and were discharged on the same day of admission. Two patients developed hydroceles that responded well to conservative management. At mean follow-up of 12.7±2months (range=8-38.4months), there was no recurrence, no testicular atrophy.
Conclusion:
Laparoscopic repair of RIH in infancy and childhood is an attractive option that avoids the difficulties of redo surgery in scarred operative field with delicate structures liable to injury even with expert operator.
