Single-center, retrospective study of the outcome of laparoscopic inguinal herniorrhaphy in children

Abstract

Laparoscopic hernia repairs are used increasingly in children.The purpose of this single-center cohort observational research study was to analyze the outcome of children treated surgically for unilateral or bilateral inguinal hernia using laparoscopy.We did a STROBE-compliant retrospective outcome analysis of pediatric, laparoscopic hernia repair. Consecutive laparoscopic herniorrhaphies in 123 children done between March 2, 2010, and March 1, 2014, were included in this analysis. Data analysis was based on reviewing the hospital records and a prospective questionnaire. We evaluated postoperative hernia recurrence rate, occurrence of postoperative complications, duration of postoperative pain medication, and wound cosmesis.We first performed laparoscopic inguinal herniorrhaphy according to the techniques described by Schier et al and Becmeur et al in March 2010. We treated 46 girls and 77 boys with laparoscopically confirmed inguinal hernias, and their ages ranged from 0 to 16 years. Of these, 77 children suffered from unilateral hernias, 30 from unilateral hernias with contralateral patency of the vaginal process, and 16 from indirect bilateral hernias. The median follow-up interval was 38 months (range: 13-58 months). Overall, 8 (6.5%) of these 123 patients experienced a recurrence of the inguinal hernia. Two patients (1.6%) suffered a postoperative infection. Postoperative pain medication was administered by parents for 1 to 3 days in 67 (63.8%) of the 105 families who answered the question, and no pain medication was administered by 5 (4.0%) parents. Wound cosmesis was rated by the parents as invisible or barely visible in 106 (86.2%) of 123 patients and esthetically disturbing in 4 (3.2%) children.Laparoscopic inguinal hernia repair carries a learning curve and is safe and efficient in children thereafter. Further prospective studies are required to evaluate the long-term outcome of laparoscopic inguinal hernia repair in children.

Profile of Contralateral Patent Processus Vaginali in Pediatric Patients with Unilateral Inguinal Hernia

“…There were 11 cases of contralateral PPV or 27.5% for all ages, contrary to the finding of Rothenberg and Barnet that stated that the incidence of <1 year contralateral hernia was 100% and 68.5% for ages >1 year (2) . However, the finding of this study is closer to the results of previous studies that pointed out 14-41% incidence of contralateral hernias (21) . Unlike previous studies that only mentioned the incidence of contralateral hernias at 11%, this study had a nearly double higher result (2,4,10) .…”

Single-incision approach for bilateral inguinal hernia repair in children

“…[ 11 , 12 , 15 ] In addition, we note that this recurrence rate is significantly lower than reported in the relevant literature. [ 7 , 21 ] According to the findings of reoperation, we speculated that the causes of recurrence seem to be failure to ligate the hernia sac high enough at the internal inguinal rings. Grosfeld et al believe that the factors affecting recurrence appear to be failure to ligate the hernia sac at the internal ring or close the internal ring tightly, operative trauma leading to injury of the inguinal canal, postoperative hematoma, and wound infection.…”

Análise epidemiológica clínico-cirúrgica pós-herniorrafia inguinal bilateral

“…A principal intercorrência resultou em recidiva unilateral pelo menos seis meses após, contudo a presente amostra se associa a profissões relacionadas ao aumento do risco absoluto para hérnia inguinal 3,4 . Ainda que média de recidiva pós-herniorrafia esteja estimada em 6,5% 16 , outros estudos indicam que recidiva pós-herniorrafia pode ser quase nula em mais de 90% dos casos seguidos por até 8 anos 17 . Ademais, detecção de recidivas depende, em essência, do número de pacientes estudados e do tempo de seguimento pós-operatório 16 .…”

“…Ainda que média de recidiva pós-herniorrafia esteja estimada em 6,5% 16 , outros estudos indicam que recidiva pós-herniorrafia pode ser quase nula em mais de 90% dos casos seguidos por até 8 anos 17 . Ademais, detecção de recidivas depende, em essência, do número de pacientes estudados e do tempo de seguimento pós-operatório 16 .…”