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Published on: December 23, 2022
Optimizing surgical techniques for the repair of inguinal hernias in infants
Zane J Hellmann1, J Leslie Knod2, Afif N Kulaylat3
1Yale New Haven Children's Hospital, Division of Pediatric Surgery, New Haven, CT, USA.
Insights
For infants under 6 months, specific techniques in inguinal hernia repair (IHR) can significantly lower recurrence rates. Cauterizing the internal ring and using permanent sutures in laparoscopic IHR, or performing diagnostic laparoscopy in open IHR, are key findings.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hernia Repair Outcomes
Background:
- Laparoscopic inguinal hernia repair (IHR) is increasingly used in infants, but data comparing techniques and outcomes to open IHR are limited.
- This study focuses on infants under 6 months undergoing primary IHR.
Purpose of the Study:
- To evaluate the impact of specific surgical techniques on subsequent inguinal hernia rates in infants.
- Investigating the effect of internal ring cauterization and permanent suture use in laparoscopic IHR.
- Assessing the benefit of diagnostic laparoscopy during open IHR.
Main Methods:
- A multicenter retrospective study of 1532 infants (<6 months) who underwent primary IHR between 2018-2019.
- Data collected on patient demographics, operative techniques (laparoscopic vs. open), and subsequent hernia incidence.
- Analysis focused on recurrent ipsilateral and metachronous contralateral hernias.
Main Results:
- Laparoscopic IHR with ring cauterization and permanent sutures showed significantly lower ipsilateral recurrence (0.5%) compared to standard laparoscopic IHR (6.2%).
- Open IHR with diagnostic laparoscopy had significantly lower contralateral recurrence (1.4%) compared to standard open IHR (3.8%).
- Recurrence rates with these specific techniques were comparable to the alternative surgical approach.
Conclusions:
- Cauterizing the internal ring and using permanent sutures during laparoscopic IHR reduces subsequent hernia rates in infants.
- Performing diagnostic laparoscopy during open IHR also lowers subsequent hernia rates in this population.
- These techniques offer improved outcomes for primary inguinal hernia repair in infants <6 months old.
Background:
Laparoscopic inguinal hernia repair (IHR) has become increasingly popular in children, particularly in infants <6 months old, despite limited data on technical variations and outcomes relative to open IHR. This multicenter retrospective study examined how rates of subsequent inguinal hernias in infants were affected by cauterizing the internal ring and using permanent suture during laparoscopic IHR. We also assessed the impact of performing diagnostic laparoscopy during open IHR.
Methods:
Patients <6 months old who underwent primary IHR between 1/1/2018 and 12/31/2019 were identified at 14 children's hospitals within a regional clinical research consortium. Information was collected regarding patient demographics, operative technique, and incidence of subsequent inguinal hernia (recurrent ipsilateral and metachronous contralateral inguinal hernia).
Results:
Among 1532 infants identified, 1016 (66.3 %) underwent open IHR and 516 (33.7 %) underwent laparoscopic IHR. Median time from primary IHR to data entry was 6 years. Performing ring cauterization and using permanent suture during laparoscopic IHR was associated with a significantly lower incidence of recurrent ipsilateral hernia (0.5 % versus. 6.2 %, p < 0.01), comparable to the recurrence rate after open IHR (0.5 % versus 1.2 %, p = 0.40). Similarly, diagnostic laparoscopy during open IHR was associated with a significantly lower incidence of metachronous contralateral hernia (1.4 % versus 3.8 %, p = 0.03), comparable to the rate seen after laparoscopic IHR (1.4 % versus 1.2 %, p = 0.79).
Conclusion:
In infants <6 months old undergoing primary IHR, rates of subsequent inguinal hernias can be significantly reduced by cauterizing the internal ring and using permanent suture during laparoscopic IHR and by performing diagnostic laparoscopy during open IHR.
