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Paediatric laparoscopic inguinal hernia repair: Level of disconnection of peritoneal cuff - An observational study
Md Mokarram Ali1, Rashi Rashi1, Amit Kumar Sinha1
1Department of Pediatric Surgery, AIIMS, Patna, Bihar, India.
Insights
Distal disconnection of the hernia sac in pediatric laparoscopic inguinal hernia repair leads to less post-operative pain and shorter hospital stays. While recurrence rates were lower with distal disconnection, further studies are needed to confirm significance.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Inguinal hernia is a common pediatric surgical condition.
- Laparoscopic repair is an increasingly popular alternative to open surgery.
- Techniques for laparoscopic repair vary, including the point of hernia sac disconnection.
Purpose of the Study:
- To compare outcomes between proximal and distal disconnection of the hernia sac in laparoscopic inguinal hernia repair.
- To evaluate the impact of disconnection site on post-operative pain, hospital stay, and recurrence.
Main Methods:
- A retrospective observational study of 95 pediatric patients undergoing laparoscopic inguinal hernia repair.
- Patients were divided into two groups: Group A (proximal disconnection) and Group B (distal disconnection) of the hernia sac.
- Outcomes analyzed included post-operative pain, hospital duration, and recurrence rates.
Main Results:
- Distal disconnection (Group B) was associated with significantly less post-operative pain (3 vs. 33 patients) and shorter hospital stays (1.8 vs. 2.36 days) compared to proximal disconnection (Group A).
- Recurrence rates were 8% in Group A and 0% in Group B, though this difference did not reach statistical significance.
- The P-values for pain and hospital stay were <0.001 and 0.0076, respectively.
Conclusions:
- Disconnection of the hernia sac distal to the deep inguinal ring (DIR) is associated with reduced post-operative pain and shorter hospital stays in pediatric patients.
- While distal disconnection showed a trend towards lower recurrence rates, larger studies are necessary to establish statistical significance.
Introduction:
Inguinal hernia is a common surgical condition in children. Conventionally, the open approach for inguinal hernia repair has been considered the gold standard. However, in the past two decades, laparoscopic inguinal hernia repair has gained popularity among paediatric surgeons as an alternative to the open approach. Apart from good cosmesis and shorter stay at hospital, laparoscopy offers clear-cut advantages of visualising contralateral site and simultaneous repair if it is patent. Many techniques for laparoscopic inguinal hernia repair have been proposed. In this retrospective observational study, we are comparing outcomes between proximal and distal disconnection of hernia sac.
Materials And Methods:
Ninety-five patients with inguinal hernia were studied in two groups. Group A included 50 patients in which hernia sac was disconnected from the peritoneal cuff proximal to deep inguinal ring (DIR). Group B included 45 patients in which hernia sac was disconnected distal to DIR. Various sociodemographic parameters and intraoperative findings were compared. Outcomes were analysed in terms of post-operative pain, duration of stay at the hospital and recurrences.
Results:
In group A, there were 46 males and four females with mean age of 4.01 years with standard deviation (SD) of 2.96. Group B included 37 males and eight females with mean age of 5.09 years with SD of 3.56. Excess post-operative pain was observed in 33 patients in Group A with proximal disconnection of hernia sac whereas it was seen in only three patients in Group B with distal disconnection of sac. The P was 0.001 which was highly significant. The duration of stay in the hospital was more in Group A (2.36 ± 1.22 days) as compared to Group B (1.8 ± 0.66 days) with a P of 0.0076 which was significant. Hernia recurrence was seen in four out of 50 patients in Group A (8%) as compared to no recurrence in Group B. However, the difference was not significant.
Conclusion:
The disconnection of hernia sac distal to DIR is associated with less post-operative pain and shorter duration of hospital stay. There is less recurrence seen in distal disconnection of hernia sac as compared to proximal disconnection; however, to achieve the level of significance, a large cohort study is required.
