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Outcomes of laparoscopic incarcerated inguinal hernia repair in children
Brigitta Balogh1, Dániel Hajnal1, Tamás Kovács1
1Department of Pediatrics, Division of Pediatric Surgery, University of Szeged, Szeged, Hungary.
Insights
Laparoscopic inguinal hernia repair (LIHR) in children is effective for incarcerated hernias, with low recurrence rates. The hook method shows significantly lower recurrence than the purse-string technique.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic inguinal hernia repair (LIHR) is increasingly used, but its application in pediatric incarcerated inguinal hernias requires further clarification.
- This review focuses on the outcomes of LIHR specifically for incarcerated inguinal hernias in children.
Purpose of the Study:
- To analyze the outcomes of laparoscopic repair for incarcerated inguinal hernias in pediatric patients.
- To compare the efficacy and complication rates of different surgical techniques used in LIHR for incarcerated hernias.
Main Methods:
- A comprehensive literature search was conducted on PubMed using keywords: 'laparoscopic', 'incarcerated', 'inguinal', 'hernia', and 'children'.
- Data extracted included patient demographics, hernia characteristics, operative techniques (hook vs. purse-string), intraoperative findings, complications, and recurrence rates.
- A total of 689 pediatric incarcerated inguinal hernias from 15 articles published between 1998 and 2018 were analyzed.
Main Results:
- The study analyzed 689 pediatric incarcerated inguinal hernias, with a median patient age of 22.4 months.
- Intraoperative reduction was necessary in 43.5% of cases, with incarcerated contents including intestine, ovary, omentum, appendix, and Meckel's diverticulum.
- The overall recurrence rate was 0.73%, with the purse-string technique showing a significantly higher recurrence rate (1.6%) compared to the hook method (0%). Testicular atrophy occurred in 0.15% of cases.
Conclusions:
- Laparoscopic inguinal hernia repair is a safe and effective option for pediatric incarcerated inguinal hernias.
- While both hook and purse-string methods are used, the hook technique is associated with a significantly lower recurrence rate.
- The study highlights the importance of technique selection in minimizing recurrence after LIHR for incarcerated inguinal hernias in children.
Aim:
Laparoscopic inguinal hernia repair (LIHR) is gaining widespread acceptance, but its role in the management of incarcerated cases is not well outlined. This review analyses the outcomes of laparoscopic repair of incarcerated inguinal hernia in children.
Patients And Methods:
Literature was searched on PubMed® using terms 'laparoscopic', 'incarcerated', 'inguinal', 'hernia' and 'children'. Age, sex, side, sac content, operative technique, follow-up period, complication and recurrence rate were analysed.
Results:
Fifteen articles with 689 paediatric incarcerated inguinal hernias were identified between 1998 and 2018. Median age of patients was 22.4 months (2 weeks-16 years; M:F = 2.2:1). Side was mentioned in n = 576: n = 398 (69.1%) right and n = 178 (30.9%) left. In n = 355 (51.5%) manual reduction and delayed surgery (MRDS), in n = 34 (4.9%) manual reduction in general anaesthesia (MRGA) followed by emergency LHR and in n = 300 (43.5%) intraoperative reduction (IOR) was necessary. Incarcerated contents were documented in n = 68: intestine n = 36 (52.9%), ovary n = 14 (20.6%), omentum n = 11 (16.2%), appendix n = 5 (7.4%) and Meckel's diverticulum n = 2 (2.9%). Among the n = 18 girls in IOR group, n = 14 (77.8%) had ovaries incarcerated. For LHR, the hook method was used in 376 (54.6%) and purse-string suture in 313 (45.4%), with two conversions in IOR group. Mean followup was 15 months (3-80 months), with one (0.15%) testicular atrophy, and 4 (0.58%) recurrences in MRDS and 1 (0.15%) in IOR. All five cases were closed with pursestring technique. Total recurrence rate was 0.73%; significantly higher (P = 0.014) with pursestring (n = 5, 1.6%) than with the hook (none).
Conclusion:
Hook and purse-string methods are equally popular in LHR for paediatric incarcerated hernias, with 50% hernia reductions possible at the time of surgery. Recurrence rate is low and comparable with non-incarcerated hernias; however, it is significantly higher in purse-string method than hook technique.
