Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients of all ages
Section snippets
Operation in the first half of the series
The technique has been described elsewhere [6], [7]. Female patients were given general endotracheal anesthesia and then placed in the Trendelenberg position. A 5-mm port was inserted through the umbilicus. A pneumoperitoneal pressure of 8–10 mm Hg was created. The internal opening of the hernia was confirmed, and the contralateral side was also inspected. Two more 3-mm ports were placed medial to the anterior superior iliac spine into the peritoneal cavity under telescopic vision. A 4/0
Results
The first group, in which 225 hernias were repaired, contained 164 patients. The TL group, in which 226 hernias were repaired, contained 150 patients (Table 5). The differences in the sex ratio of boys to girls (129:25 vs 112:38) and in the mean ages (50.84 ± 48.15 vs 45.59 ± 47.95 m) between the 2 groups were not statistically significant.
Because there were more younger patients in the TL group (37/150 vs 12/164; P = .0256), more bilateral inguinal hernias were discovered and repaired during
Discussion
There is no muscular weakness in pediatric inguinal hernia. It becomes clear to many pediatric surgeons that there is no need to have muscular strengthening procedures in hernia repair in this group of patients [8].
In a large series of 6361 child inguinal hernias over a 35-year period treated with open herniotomy, the recurrence rate was found to be 1.2% [9]. It should be possible using laparoscopic repair to avoid some of the causes of recurrence in open herniotomy. These include failure to
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Cited by (58)
Comparison of intra- and extra-corporeal laparoscopic hernia repair in children: A systematic review and pooled data-analysis
2021, Journal of Pediatric SurgeryCitation Excerpt :All studies (intra-corporeal repair in n = 738 children and extra-corporeal repair in n = 2942 children) assessed ipsilateral recurrence rate (Table 4) which varied from 0–4.9% with the highest recurrence reported by Chan et al. (n = 314 children). They reported a recurrence rate of 4.9% in the group that used an intra-corporeal technique with injection of normal saline extra-peritoneally (n = 164 children) compared to 0.4% in the intervention group that used an intra-corporeal technique with injection of normal saline extra-peritoneally before tying an airtight knot [12]. Five studies (n = 664 children; one study comparing intra-corporeal closure and four comparing extra-corporeal closure) reported zero recurrent hernias during a follow-up period varying from 3 months until 1 year.
One trocar needlescopic assisted inguinal hernia repair in children: a novel technique
2018, Journal of Pediatric SurgeryInguinal Hernia
2017, Clinics in PerinatologyCurrent concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era
2016, Seminars in Pediatric SurgeryLaparoscopic management of recurrent inguinal hernia in childhood
2015, Journal of Pediatric Surgery
Presented at the 40th annual meeting of the Pacific Association of Pediatric Surgeons, Queenstown, New Zealand, April 15-19, 2007.