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Fifteen Years Experience with Laparoscopic Inguinal Hernia Repair in Infants and Children
Rafik Shalaby1, Mohamed Abd Alrazek1, Adham Elsaied2
11 Department of Pediatric Surgery, Al-Azhar University , Cairo, Egypt .
Insights
Laparoscopic inguinal hernia repair (LIHR) in children is safe and effective, with low recurrence rates. This technique allows for the detection and repair of contralateral hernias and other inguinal pathologies.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic inguinal hernia repair (LIHR) is increasingly recognized for its feasibility, safety, and efficacy in pediatric patients.
- This study reviews a 15-year experience with LIHR in infants and children, focusing on innovative laparoscopic techniques.
Purpose of the Study:
- To review and evaluate the experience with laparoscopic inguinal hernia repair (LIHR) in infants and children over 15 years.
- To present and assess innovations in laparoscopic techniques for pediatric inguinal hernia repair.
Main Methods:
- A retrospective study of 1284 pediatric patients with congenital inguinal hernia (CIH) undergoing LIHR from October 2000 to October 2015.
- Outcome measurements included operative time, hospital stay, recurrence, hydrocele formation, testicular atrophy, iatrogenic ascent of the testis, and cosmetic results.
Main Results:
- 1284 patients (918 males, 366 females) aged 6-78 months underwent successful laparoscopic repair without major intraoperative complications.
- Contralateral defects found in 22.90%, direct inguinal hernias in 1.17%, and femoral hernias in 0.23%.
- Recurrence occurred in 0.98% of early cases, with no recurrence in later cases. Hydrocele occurred in 2.07% of males; no testicular atrophy or iatrogenic ascent of the testis was noted.
Conclusions:
- LIHR performed by experienced surgeons is a safe and effective treatment for pediatric inguinal hernias.
- The laparoscopic approach facilitates the identification and repair of contralateral and other inguinal pathologies.
- Tailoring laparoscopic techniques to individual cases based on available resources and expertise is recommended.
Background:
Laparoscopic inguinal hernia repair (LIHR) is gaining popularity with more studies validating its feasibility, safety, and efficacy. The aim of this work is to review our experience with LIHR in infants and children during the past 15 years, and present and evaluate our innovations of laparoscopic techniques.
Patients And Methods:
A retrospective study of 1284 patients with congenital inguinal hernia (CIH) subjected to different techniques of LIHR from October 2000 to October 2015. The main outcome measurements included the following: operative time, hospital stay, hernia recurrence, hydrocele formation, testicular atrophy, iatrogenic ascent of the testis, and cosmetic results.
Inclusion Criteria:
All patients with CIH who were managed by LIHR during the period of study. They were bilateral cases, recurrent hernias, unilateral hernia in obese child, unilateral hernia with associated infantile umbilical hernia, and unilateral hernia with questionable contralateral side.
Results:
A total of 1284 patients with CIH were corrected with different laparoscopic procedures. They were 918 males and 366 females. The age range was variable from 6 to 78 months (mean 28.32 ± 24.46 months). All cases were completed laparoscopically without major intraoperative complications. Contralateral hernial defects were found in 294 patients (22.90%), a direct inguinal hernia (IH) was discovered in 15 patients (1.17%), and a femoral hernia was discovered in 3 patients (0.23%). Recurrence occurred in 9 boys (0.98%) who were among the early cases; however, in later group, no recurrence had been detected. Hydrocele occurred in 19 cases (males) (2.07%), without detection of testicular atrophy or iatrogenic ascent of the testis.
Conclusion:
Our results lead us to believe that LIHR by expert hands is safe and effective. It enables the surgeon to discover and repair contralateral hernia and all forms of IHs. One should be able to tailor a suitable technique for each case according to the resources and expertise.
