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Laparoscopic Inguinal Hernia Repair in Children: To Cut or Not to Cut is the Question?
Kirtikumar J Rathod1, Rupesh Sikchi1, Ayushi Vig1
1Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Insights
Laparoscopic pediatric hernia repair is effective whether the sac is divided or not. Not dividing the sac significantly reduces operative time without affecting outcomes or recurrence rates.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Laparoscopic repair of pediatric inguinal hernias is increasingly common.
- A lack of consensus exists regarding the optimal surgical technique.
Purpose of the Study:
- To compare the outcomes and complications of two laparoscopic pediatric hernia repair techniques.
- To evaluate the impact of dividing the hernial sac on operative time and recurrence.
Main Methods:
- Retrospective study of 114 pediatric patients undergoing laparoscopic inguinal hernia repair.
- Patients were divided into two groups: hernial sac divided vs. not divided before suturing.
- Data analyzed included operating time, complications, hospital stay, and recurrence, using Student's t-test and Fischer exact test.
Main Results:
- No significant differences in age, gender, hernia side, complications, or hospital stay between groups.
- Operating duration was significantly shorter when the hernial sac was not divided (65.7 min vs. 92.5 min).
- Hernia recurrence rates were comparable (3.8% vs. 1.6%).
Conclusions:
- Laparoscopic pediatric hernia repair with or without dividing the peritoneal sac yields comparable results.
- Omitting the division of the hernial sac can lead to a shorter operative duration.
Context:
Laparoscopic repair of pediatric inguinal hernia is gaining popularity, however there is no consensus about the technique of operation.
Aims:
The aim of the study was to compare the results and complications of two techniques of laparoscopic pediatric hernia repair.
Settings And Design:
This retrospective study was conducted at the Department of Pediatric Surgery in All India Institute of Medical Sciences (AIIMS), Jodhpur.
Subjects And Methods:
All children who underwent laparoscopic inguinal hernia repair at AIIMS, Jodhpur, during the period of September 2016-March 2019 were retrospectively studied. Parameters studied included age, gender, side of hernia, technique used, operating time, complications, and hospital stay. Patients were divided into two groups depending on whether the hernial sac was divided or not divided before taking a purse-string suture.
Statistical Analysis Used:
Student's t-test and Fischer exact test were used to analyze data.
Results:
A total of 114 patients were included in the study. The median age was 36.4 months. Hernial sac was divided before suturing in 53 patients, while sac was left intact in 61 patients. The mean follow-up was 11.4 months (range: 4-16). Age, gender, side of hernia, complications, and hospital stay were comparable in both groups. There was a significant difference between the mean operating duration in patients who underwent division of hernia sac compared to patients in whom the sac was not divided before putting purse-string suture (92.5 min [45-150] vs. 65.7 [30-90], respectively, P = 0.0101). Hernia recurrence (3.8% in Group A vs. 1.6% in Group B) was comparable in the two groups.
Conclusions:
Laparoscopic pediatric hernia repair done with or without dividing the peritoneal sac gives comparable results, however operative duration is less if sac is not divided.
