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Published on: November 12, 2021
Laparoscopic iliopubic tract repair for pediatric inguinal hernia has very low recurrence: an Indian experience
Sunil Kumar Nayak1, Ramakrishnan Parthasarathi1, Raghavendra Gupta G H V1
1Minimal Access Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
Insights
Laparoscopic iliopubic tract (IPT) repair is a safe and effective treatment for pediatric inguinal hernias, with low recurrence rates. This minimally invasive approach helps identify associated conditions like contralateral patent processus vaginalis (CPPV).
Area of Science:
- Minimally invasive surgery
- Pediatric surgery
- Hernia repair
Background:
- Inguinal hernias are common in children.
- Traditional surgical methods can have limitations.
- Laparoscopic iliopubic tract (IPT) repair offers a minimally invasive alternative.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic IPT repair in pediatric patients.
- To document recurrence rates and postoperative complications.
- To assess the diagnostic benefits of laparoscopy for associated pathologies.
Main Methods:
- Retrospective analysis of hospital records for 190 children (238 repairs) aged 1-17 years.
- Laparoscopic IPT repair involved approximating the iliopubic tract to the conjoint tendon.
- Data collected included demographics, diagnostic variations, operative details, complications, and follow-up.
Main Results:
- No recurrence was observed in 166 children followed, with 96 exceeding 3 years post-surgery.
- Contralateral patent processus vaginalis (CPPV) was detected laparoscopically in 18.3% of cases.
- Two patients developed a contralateral hernia; further investigation is warranted.
Conclusions:
- Laparoscopic IPT repair is a reproducible and safe procedure for pediatric inguinal hernias.
- The technique is beneficial for identifying CPPV, aiding in complete surgical management.
- Long-term follow-up is recommended to monitor for late recurrences and contralateral hernia development.
Background:
The aim of this study is to document results of laparoscopic iliopubic tract (IPT) repair for inguinal hernia in the pediatric age group.
Methods:
Hospital records of 190 children who underwent IPT repair between January 2015 and January 2020 were analyzed retrospectively for demographic details, variations between clinical, radiological and laparoscopic diagnosis, associated pathologies, operative time, hospital stay, postoperative complications and follow-up. The internal ring was narrowed by approximating IPT to conjoint tendon using 3-0 polypropylene continuous or interrupted suture.
Results:
In total, 238 IPT repairs were done under general anesthesia in 190 children aged between 1 and 17 years. 7.9% of children had phimosis, and three children had hydrocele. Three patients had undescended testis and another three IPT repairs were done in cases who presented with appendicitis. Contralateral patent processus vaginalis (CPPV) was detected at the time of laparoscopy in 18.3% of cases. Thus far, 166 children had been followed, and no recurrence was observed in any of these 96 of whom have completed more than 3 years after their surgery. However, two patients developed hernia on the contralateral side.
Conclusions:
Laparoscopy is beneficial to pick up CPPV. Laparoscopic IPT repair for pediatric inguinal hernia is reproducible and safe with the least recurrence reported thus far. However, further follow-up is needed. Moreover, development of contralateral hernia needs to be investigated.
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