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Outcomes from Early Experience with Laparoscopic Inguinal Hernia Repair Versus Open Technique: Navigating the
Rachid Kaddoura1, Issam El Rassi1, Zainab Al Awadi1
1Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
Blood-filled heart valve cysts, common in infants, typically resolve within six months. A unique case involved an 11-month-old successfully treated for a pulmonary valve cyst, highlighting atypical presentations.
Area of Science:
- Cardiology
- Pediatric Pathology
- Medical Case Reports
Background:
- Blood-filled cysts of heart valves are commonly identified in postpartum infant autopsies.
- These cysts present as nodules, predominantly in infants under two months old.
- They typically resolve spontaneously by six months of age.
Purpose of the Study:
- To report a unique case of a blood-filled cyst in an 11-month-old pediatric patient.
- To highlight the clinical presentation and successful management of a rare late-presenting case.
- To emphasize the need for further investigation into diagnostic and therapeutic strategies for these cysts.
Main Methods:
- Case report of an 11-month-old female presenting with a pulmonary valve cyst.
- Review of clinical presentation, diagnostic imaging, and treatment course.
- Literature review on pediatric blood-filled heart valve cysts.
Main Results:
- A blood-filled cyst was identified on the posterior leaflet of the pulmonary valve in an 11-month-old girl.
- The cyst was successfully treated, indicating potential for intervention beyond the typical neonatal period.
- This case extends the known age range for symptomatic presentation and successful management.
Conclusions:
- Blood-filled heart valve cysts can present beyond the neonatal period and may require intervention.
- This case underscores the variability in presentation and the need for tailored diagnostic and treatment approaches.
- Further research is essential to elucidate optimal management strategies for blood-filled cardiac cysts in children.
Objectives:
This study aimed to evaluate the outcomes of laparoscopic inguinal hernia repair (LIHR) regarding postoperative pain, recurrence rates, duration of hospital stay and other postoperative outcomes within the context of a tertiary care teaching hospital in South India, and the initial experience of laparoscopic repairs. The current consensus in the literature often suggests LIHR as superior to open inguinal hernia repair (OIHR).
Methods:
This single-centre, retrospective, observational study was conducted at the Jawaharlal Institute of Postgraduate Education and Research, Puducherry, India, from January 2011 to September 2020. All patients who underwent elective OIHR and LIHR were included. Data on the patients demographics, comorbidities, hernia type, mesh characteristics, surgery duration, hospital stay and immediate postoperative complications were collected and analysed.
Results:
A total of 2,690 OIHR and 158 LIHR cases were identified. The demographic profiles, hospital stay and complication rates were similar in both groups. However, surgical site infection was present exclusively in the OIHR group (3.55% versus 0.0%; P <0.05). The timeline for returning to normal activities was statistically shorter for the LIHR group (6 versus 8 days; P <0.05). The most frequent immediate complication in the LIHR group was subcutaneous emphysema (6.54% versus 0.0%; P <0.05). Recurrence (9.23% versus 3.61%; P = 0.09) and chronic pain (41.53% versus 13.55%; P <0.05) were higher in the LIHR group.
Conclusion:
Lower recurrence and chronic pain rates were observed with OIHR in the initial experience with LIHR in the hospital. However, LIHR had significant advantages concerning faster patient recovery and lower rates of surgical site infections. While the results contribute an interesting deviation from the standard narrative, they should be interpreted within the context of a learning curve associated with the early experience of the research team with LIHR.
