Scarless laparoscopic repair of epigastric hernia in children

Abstract

Background Despite the small size of the incision, the scar left by open repair of epigastric hernia in children is unaesthetic. Few laparoscopic approaches to epigastric hernia repair have been previously proposed, but none has gain wide acceptance from pediatric surgeons. In this study, we present our experience with a scarless laparoscopic approach using a percutaneous suturing technique for epigastric hernia repair in children. Methods Ten consecutive patients presenting with epigastric hernia 15 mm or further from the umbilicus were submitted to laparoscopic hernia repair. A 5-mm 308-angle laparoscope is introduced through a umbilical trocar and a 3-mm laparoscopic dissector is introduced through a stab incision in the right flank. After opening and dissecting the parietal peritoneum, the fascial defect is identified and closed using 2-0 polyglactin thread through a percutaneous suturing technique. Intraoperative and postoperative clinical data were collected. Results All patients were successfully submitted to laparoscopic epigastric hernia repair. Median age at surgery was 79 months old and the median distance from the umbilicus to the epigastric defect was 4 cm. Operative time ranged from 35 to 75 min. Every hernia was successfully closed without any incidents. Follow-up period ranges from 2 to 12 months. No postoperative complications or recurrence was registered. No scar was visible in these patients. Conclusion This scarless laparoscopic technique for epigastric hernia repair is safe and reliable. We believe this technique might become gold standard of care in the near future.

Epigastric Hernias in Children: A Personal Series and Systematic Review of the Literature

“…8 Multiple epigastric hernias and concomitant abdominal wall hernias were identified in a small proportion of children. In total, 12 of the 81 patients (15%) had a concomitant umbilical hernia at presentation, 2,5,8 and six (8%) of the 79 children that underwent operative repair were found to have two or three separate linea alba defects at the time of surgery. 2,5 The duration of follow-up varied greatly (►Table 1), but no postoperative complications or recurrent epigastric hernias were reported.…”

“…In recent years, several publications have advocated laparoscopic repair of pediatric epigastric hernias. [3][4][5][6]8,9 Purported advantages include quicker surgery, 6 improved cosmesis, [3][4][5] reduced postoperative pain, 6 and the identification of multiple linea alba defects. 6 No study has compared open versus laparoscopic repair of epigastric hernias in children.…”

Clinical and radiological features of incarcerated hernia

“…This has been attributed to the presence of the falciform ligament, which covers the visceral part of the fascial abnormality. 44 On the other hand, previous investigations reported that preperitoneal fat might be incarcerated and cause relevant complications. 44,45 Despite being rare, evidence shows that incarceration might occur with lateral ventral or Spigelian hernias.…”

“…44 On the other hand, previous investigations reported that preperitoneal fat might be incarcerated and cause relevant complications. 44,45 Despite being rare, evidence shows that incarceration might occur with lateral ventral or Spigelian hernias. These types of hernias occur between the linea semilunaris laterally and the rectus abdominis muscle medially, secondary to defects in the aponeurosis of the transverse abdominis.…”

Laparoscopic intraperitoneal onlay mesh for pediatric incisional hernia—a case report

“…In the pediatric population, primary closure has generally been favored. A few laparoscopic approaches with direct suturing have been proposed [ 3 , 4 ]; however, there have been no reports of laparoscopic repair with the use of mesh in the pediatric population. Direct repair without mesh is associated with high rates of recurrence in adults (direct suture, 12–54%; tension-free repair, 2–36%) [ 5 ].…”