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Establishment of Single-Port, Laparoscopic, Pediatric Hernia Repair in a Developing Country
Nripesh Rajbhandari1, Banira Karki1, Laura C Guglielmetti2
1Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
Insights
Single-port, laparoscopic, needle-assisted, inguinal hernia repair (LNAR) in children is safe and cost-effective in developing countries. This minimally invasive technique reduces surgical trauma and hospital stay, despite an initial learning curve.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- Inguinal hernias are common in children.
- Traditional open repair can involve significant surgical trauma.
- Laparoscopic techniques offer potential benefits but are not widely adopted in developing countries.
Purpose of the Study:
- To evaluate the safety and cost-effectiveness of single-port, laparoscopic, needle-assisted, inguinal hernia repair (LNAR) in children in a developing country.
- To assess the feasibility of implementing advanced laparoscopic procedures in resource-limited settings.
Main Methods:
- A single-center study included 117 children undergoing LNAR between January 2017 and December 2018.
- Intraoperative and postoperative complications were meticulously recorded.
- Hospital costs were analyzed and compared to open procedures.
Main Results:
- 148 procedures were performed with no intraoperative complications.
- Overall complication rate was 5.1%, including residual hydrocele and wound seroma.
- Operative time and hospital stay significantly decreased in the second year, indicating a learning curve.
- Total costs were below USD 80 per patient, comparable to open surgery.
Conclusions:
- Single-port LNAR is a safe and cost-effective option for pediatric inguinal hernia repair in developing nations.
- The procedure demonstrates a learning curve, with improved efficiency over time.
- This approach can reduce surgical trauma and healthcare costs in resource-limited settings.
Abstract:
Single-port, laparoscopic, needle-assisted, inguinal hernia repair (LNAR) in children intends to reduce surgical trauma and enables contralateral assessment and closure of contralateral patent processus vaginalis if necessary. The aim of the present study was to demonstrate that laparoscopic inguinal repair can be performed safely and cost-effectively in a developing country where laparoscopy is not yet commonly used. In this single-center study, we included all children undergoing LNAR between January 2017 and December 2018. Intraoperative and postoperative complications and hospital costs were assessed. We performed 148 hernia repair operations in 117 children (age range 1 month to 15 years). Mean operative time was 20.8 ± 9.4 minutes. Mean length of hospital stay amounted to 10 ± 7.6 hours, with 77.7% of patients discharged within 6 hours. No intraoperative complications occurred in any patient. Complications occurred in six (5.1%) patients. Three (2.5%) patients experienced residual hydrocele, two (1.4%) patients suffered wound site seroma, and one (0.67%) patient experienced recurrent inguinal hernia 6 months after the initial repair. All complications occurred during the first year of the study period. Likewise, operative time (P < .0001) as well as duration of hospital stay (P < .0001) was significantly shorter in the second year. Total costs for complete treatment were below USD 80 per patient, which is comparable with the costs associated with open herniotomy at the same institution. Single-port LNAR and hydrocele repair in children were established safely and cost-effectively in a developing country. Nevertheless, the procedure was associated with a steep learning curve.
