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Published on: November 12, 2021
Laparoscopic surgery: an effective and safe surgical method of pediatric inguinal hernia repair
Eun Jung Kim1, Chaeyoun Oh1, Jun Won Um1
1Department of Surgery, Korea University Ansan Hospital, Ansan, Korea.
Insights
Laparoscopic inguinal hernia repair in children is safe and feasible. It offers shorter operation times and better detection of contralateral hernias compared to open repair.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Open repair (OR) is the standard for pediatric inguinal hernia (IH).
- Laparoscopic repair techniques are gaining traction for IH treatment.
- Evaluating laparoscopic IH repair's safety and feasibility is crucial.
Purpose of the Study:
- To compare the safety and feasibility of laparoscopic IH repair versus OR in children.
- To assess operative times and recurrence rates for different IH repair methods.
- To investigate the detection of contralateral patent process vaginalis (PPV) during laparoscopic IH repair.
Main Methods:
- Retrospective analysis of 105 pediatric patients undergoing IH repair (Jan 2011-Oct 2019).
- Procedures included open repair (OR), laparoscopic percutaneous extraperitoneal closure (LPEC), and three-port mini-laparoscopic repair (TLR).
- Data collected on operative time, recurrence, and contralateral PPV diagnosis.
Main Results:
- Laparoscopic repair (LPEC/TLR) showed significantly shorter operative times (p < 0.001).
- Synchronous contralateral PPV repair was more common in laparoscopic groups, especially in children under 3.
- No ipsilateral recurrence observed; metachronous contralateral IH rates were similar across groups.
Conclusions:
- Laparoscopic inguinal hernia repair offers reduced operative time compared to open repair.
- Laparoscopic techniques facilitate the diagnosis and simultaneous repair of unexpected contralateral PPV.
- Laparoscopic repair is a safe and feasible alternative for pediatric inguinal hernias.
Purpose:
Inguinal hernia (IH) repair is very commonly performed in children. While open repair (OR) is the standard approach, laparoscopic repair is increasingly used. This study was aimed to investigate safety and feasibility of laparoscopic repair of pediatric IH compared to OR.
Methods:
We retrospectively enrolled 105 pediatric patients with IH repair between January 2011 and October 2019. The laparoscopic procedures performed were laparoscopic percutaneous extraperitoneal closure (LPEC), and three-port mini-laparoscopic repair (TLR). The OR was performed as per usual technique.
Results:
Thirty-nine patients underwent OR, 16 LPEC, and 50 TLR. The preoperative laterality of IH was 45 patients (42.9%) on the right side, 50 (47.6%) on the left side, and 10 (9.5%) on both sides. It was, however, diagnosed postoperatively in 27 patients (25.7%) on the right side, 38 (36.2%) on the left side, and 40 (38.1%) on both sides. Of the 63 patients who presented with unilateral IH in the laparoscopic groups, 32 (50.8%) had synchronous contralateral patent process vaginalis (PPV) which were simultaneously repaired. This was significantly more common in children under 3 years of age. Operative time in unilateral or bilateral repair was significantly shorter in the laparoscopic repair groups (p < 0.001). Ipsilateral recurrence was not observed in any group. Metachronous contralateral IH occurrence was not significantly different between groups.
Conclusion:
Laparoscopic IH repair may have benefit in terms of shorter operation time and diagnosis of unpredicted contralateral PPV compared to OR.
