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Published on: December 4, 2023
A single institution experience with Laparoscopic Hernia repair in 791 children
Wendy Jo Svetanoff1, James A Fraser1, Kayla B Briggs1
1Department of Surgery, Children's Mercy, Kansas City, USA.
Insights
This study shows that a percutaneous internal ring suturing technique for laparoscopic inguinal hernia repair in children is safe and effective. The method resulted in low complication and recurrence rates in pediatric patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic inguinal hernia repair in children has various techniques.
- This study evaluates a specific percutaneous internal ring suturing method.
Purpose of the Study:
- To assess the safety and efficacy of a percutaneous internal ring suturing technique for laparoscopic inguinal hernia repair in pediatric patients.
Main Methods:
- Retrospective review of 791 patients under 18 years old (January 2014 - March 2019).
- Utilized a percutaneous internal ring suturing technique including hydro-dissection, suture passage, and cauterization.
- Statistical significance set at p < 0.05.
Main Results:
- Median age at operation was 1.9 years.
- Median operative times were 21 min (unilateral) and 30.5 min (bilateral).
- Low complication rates: 0.4% conversion to open, 0.6% bleeding, 1.2% wound infection, 1.3% iatrogenic ascent of testis. Recurrence rate was 2.5%, with most re-repaired laparoscopically.
Conclusions:
- Percutaneous internal ring suturing is a safe and effective laparoscopic technique for pediatric inguinal hernias.
- The method demonstrates a low incidence of complications and hernia recurrence.
- This technique offers a viable option for pediatric laparoscopic hernia repair.
Introduction:
There are many described technique to performing laparoscopic inguinal hernia repair in children. We describe our outcomes using a percutaneous internal ring suturing technique.
Methods:
A retrospective review of patients under 18 years old who underwent repair between January 2014 - March 2019 was performed. A percutaneous internal ring suturing technique, involving hydro-dissection of the peritoneum, percutaneous suture passage, and cauterization of the peritoneum in the sac prior to high ligation, was used. p < 0.05 was considered significant during the analysis.
Results:
791 patients were included. The median age at operation was 1.9 years (IQR 0.37, 5.82). The median operative time for a unilateral repair was 21 min (IQR 16, 28), while the median time for a bilateral repair was 30.5 min (IQR 23, 41). In total, 3 patients required conversion to an open procedure (0.4%), 4 (0.6%) experienced post-operative bleeding, 9 (1.2%) developed a wound infection, and iatrogenic ascent of testis occurred in 10 (1.3%) patients. Twenty patients (2.5%) developed a recurrent hernia. All but two were re-repaired laparoscopically.
Conclusions:
The use of percutaneous internal ring suturing for laparoscopic repair of inguinal hernias in the pediatric population is safe and effective with a low rate of complications and recurrence.
