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Published on: November 12, 2021
Laparoscopic pediatric inguinal hernia repair: a controlled randomized study
Mohamed Abd-Alrazek1, Hatem Alsherbiny1, Mohamad Mahfouz1
1Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt.
Insights
Disconnection of the hernia sac during laparoscopic inguinal hernia repair in children is a safe and effective method. This technique demonstrates a lower recurrence rate compared to leaving the sac intact with purse-string sutures.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- Inguinal hernia repair is a common pediatric surgical procedure.
- Laparoscopic techniques for pediatric inguinal hernia repair are still under investigation.
- Various laparoscopic methods exist, necessitating comparative studies.
Purpose of the Study:
- To compare two laparoscopic techniques for congenital inguinal hernia (CIH) repair in children.
- Evaluate intracorporeal purse-string suture ligation versus sac disconnection with suturing.
- Assess operative time, recurrence rates, and postoperative complications.
Main Methods:
- Prospective randomized controlled study of 132 pediatric patients over 2 years and 8 months.
- Group I (n=66): Laparoscopic intracorporeal purse-string suture ligation of the hernia sac at the internal inguinal ring (IIR), leaving the sac intact.
- Group II (n=66): Laparoscopic disconnection of the hernia sac at the IIR with proximal suturing and peritoneal closure.
Main Results:
- 132 patients (157 hernia defects) aged 6 months to 3 years included.
- No significant difference in intraoperative complications or hospital stay between groups.
- Significant differences observed in operative time and postoperative complications, favoring sac disconnection.
Conclusions:
- Laparoscopic repair with hernia sac disconnection and peritoneal closure is a safe and feasible pediatric CIH treatment.
- This method shows a reduced recurrence rate compared to the purse-string technique with an intact sac.
Background:
Inguinal hernia repair is one of the most frequently performed surgical procedure in infants and young children. Laparoscopic hernia repair in infancy and childhood is still debatable. There are many techniques available for laparoscopic hernia repair in pediatrics. The aim of the study is to compare laparoscopic intracorporeal purse-string suture ligation of the hernia defect leaving the sac intact versus disconnection of the hernia sac with intracorporeal suturing of proximal part.
Patients And Methods:
A prospective controlled randomized study of laparoscopic repair of congenital inguinal hernia (CIH) was conducted over a period of 2years and 8months from April 2014 to December 2016. All patients were randomized into two equal groups: Group I (n=66) received intracorporeal purse string suture ligation of the hernia sac at internal inguinal ring [IIR] leaving the sac intact; and Group II (n=66) received disconnection of the hernia sac with intracorporeal suture of proximal part at IIR.
Inclusion Criteria:
Male patient with bilateral CIH, questionable other side, cases of CIH associated with umbilical hernia and parental request.
Exclusion Criteria:
Recurrent cases, complicated cases, hernia of canal of Nuck in females, inguinal hernia with undescended testis, parental refusal. The main outcome measurements were operative time, postoperative hydrocele formation, recurrence rate.
Results:
This study included 132 patients with 157 hernia defects. Their age ranged from 6months to 3years. Statistically significant differences regarding the demographic data of the groups. All cases were completed successfully without conversion. There was no statistically significant difference between groups regarding intraoperative complications and hospital stay. There was statistically significant difference in the operative time and post-operative complications between the studied groups.
Conclusions:
Laparoscopic inguinal hernia repair by disconnection of the hernia sac at the IIR with peritoneal closure is safe and feasible method. It has a lower recurrence rate than the purse string suturing leaving the sac intact.
