Laparoscopic inguinal hernia repair—a prospective personal series of 542 children

doi:10.1016/j.jpedsurg.2006.02.028

Journal of Pediatric Surgery

Volume 41, Issue 6, June 2006, Pages 1081-1084

https://doi.org/10.1016/j.jpedsurg.2006.02.028 Get rights and content

Abstract

Purpose

This series prospectively evaluates a consecutive personal series of children undergoing laparoscopic hernia repair.

Methods

A total of 712 inguinal hernias were corrected laparoscopically in 542 children (396 boys and 146 girls, aged 4 days to 14 years, median 1.6 years). The internal inguinal ring was closed with a 4-0 nonabsorbable suture using 2-mm instruments. Patients were prospectively video-documented.

Results

There were no serious intraoperative complications. Operating time was comparable to open surgery. The contralateral inner ring was open on the left side in 16% of boys and 12% of girls, and on the right side in 18% of boys and 32% of girls. Direct hernias were found in 2.3%, femoral hernias in 1%, hernias en pantalon in 0.7%, and a combination of indirect and femoral hernia in 0.2%. Follow-up to date is 1-84 months (median 39 months). There were 4.1% hernia recurrences, 0.7% hydroceles and 0.2% testicular atrophies. Cosmesis is excellent.

Conclusions

Laparoscopic inguinal hernia repair can be a routine procedure with results comparable to those of open procedures. It is well suited for recurrences. The vas remains untouched. The visualization of structures is clear and leads to a defect-specific closure. The advantages of the laparoscopic approach include the following: its technical ease, it is an outpatient procedure, the cord structures remain untouched, the type of hernia is obvious, trocar placement is identical for any side or hernia type, clear visualization of the anatomy. Routine video documentation renders the diagnostic accuracy objective and absolute. Finally, recurrences are easier dealt with, be it from a previous open or from a laparoscopic approach. Although recurrences were slightly more frequent in the early stages, now they are closer to the rate with the open procedure.

Section snippets

Materials and methods

A total of 712 inguinal hernias were repaired laparoscopically in 542 children (396 boys and 146 girls, aged 4 days to 14 years, median 1.6 years). In most of the cases, the initial diagnosis was established by a referring pediatrician and confirmed preoperatively by a hospital-based pediatric surgeon.

Postoperatively, the surgeon saw all children personally after 4 weeks. Additional follow-up was scheduled if a complication arouse such as a recurrence.

General endotracheal anesthesia was used.

Results

There was no procedure-specific complication. Only 3 hydroceles (0.7%) and 1 testicular atrophy (0.2%) occurred postoperatively. The testicular atrophy followed former incarceration. The anatomy was always obvious. The operating time from skin-to-skin ranged from 10 to 55 minutes (median 20 minutes). Most children went home the same day. Thirty-two percent of children stayed one night postoperatively because of prematurity, parenteral preference, cultural expectations, or geographical distance.

Discussion

With the laparoscopic approach, rare hernia forms such as direct or femoral hernias are easily identified. It has been shown that with open surgery, femoral hernias are diagnosed correctly in only 53%, and that the recurrence rate is 13% [10]. With laparoscopy, the correct diagnosis is straightforward [11]. This may explain why direct, femoral, and combined hernias were seen more frequently. Also, a negative diagnosis, or absent hernia, is more easily documented in the laparoscopic technique.

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This retrospective study was performed on data regarding laparoscopic inguinal hernia repair collected over one year (July 2019–2020). We carried out the laparoscopic inguinal hernia repair, closing the internal inguinal ring using a non-resorbable sliding knot suture and incorporating the transversalis fascia for reinforcement, followed by purse-string closure of the peritoneum.
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A total of seven male patients from July 2019 to 2020 were admitted to our center with a history of repaired bladder exstrophy and reducible inguinal hernias. Two patients had open inguinal hernia repair due to parental preference and five patients had laparoscopic repair. In the laparoscopic group three patients had bilateral inguinal hernias in one of them a metachronous hernia was discovered intraoperstively, and the remaining two patients had unilateral hernias, one on the right side and the other on the left side. All patients in the laparoscopic group had an uneventful recovery and were discharged within 24 h and there were no complications or recurrences during follow-up.
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Citation Excerpt :
However, with the advent of laparoscopic surgery, a number of case series emerged in the 1990s, suggesting that a laparoscopic approach to inguinal hernia was equally safe in children [17–19]. As is often the case with new surgical technology, this approach was originally met with criticism given subjectively high recurrence rates, a challenging learning curve, and unnecessary peritoneal violation with minimal added benefit outside of theoretically improved cosmesis [20,21]. However, recent meta-analyses and prospective trials suggest that both approaches have similar clinical outcomes and recurrence rates with no definitive evidence to suggest superiority of either approach [11,22,23].
Inguinal hernia repairs (IHR) are commonly performed by pediatric surgeons in the United States. The operative approach depends on surgeon preference with no definitive prospective studies comparing laparoscopic inguinal hernia repair (LIHR) versus traditional inguinal hernia repair (TIHR). We aim to assess current practice, hypothesizing that laparoscopy is increasingly used for pediatric IHR.
The Children's Hospital Association (CHA) Pediatric Health Information System was queried for IHRs performed between 01/01/2009 and 12/31/2018. Demographics, procedure type, hernia laterality, and cost were obtained. Patients were grouped by procedure type (laparoscopic/traditional).
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Laparoscopy for pediatric IHR is increasing at CHA hospitals where nearly 1 in 6 children currently undergoes a laparoscopic repair. The long-term outcomes with laparoscopic repair are worthy of future study.
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Original articleLaparoscopic inguinal hernia repair—a prospective personal series of 542 children

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

J Am Coll Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Original article
Laparoscopic inguinal hernia repair—a prospective personal series of 542 children