Laparoscopic Completely Extraperitoneal Repair of Inguinal Hernia in Children; A Single Institute Experiences with 1,257 Repairs in Comparison with Cut-down Herniorrhaphy.

Aim of the study: Conventional open herniorrhaphy in children has been reported to have 2~3% recurrence and 10~20% postoperative contralateral hernia rates. We developed a unique technique to achieve completely extraperitoneal ligation of patent processus vaginalis (PPV) without any skip areas, sparing the spermatic cord and vessels under laparoscopic control. Our technique should be theoretically superior to open repair in terms of high ligation of the PPV and routine intervention to the contralateral side. The purpose of this report is to introduce our technique and its results in comparing with the conventional cut-down herniorrhaphy.
Methods: A consecutive series of 1,585 children with inguinal hernia or hydrocele, experienced during 1996 to 2006, were analyzed. In laparoscopic PPV closure (LPC), a 2-0 suture, placed in the lower half of the internal inguinal ring through a 16-G sheath needle advanced extraperitoneally across the cord and vessels, was retrieved through the upper half of the ring by a specially devised needle, and tied up achieving completely extraperitoneal ligation of the ring. Either cut-down herniorrhaphy with or without diagnostic laparoscopy (C-D) or LPC was selected according to parental preference under informed consent.
Main results: Parents gave a more preference to LPC (LPC in 1,257 children, C-D in 308 and miscellaneous in 20). Age ranges were equal to both group LPC and CD (median, 3y). Sex distribution showed female predominance in group LPC (44% vs 27%) for postoperative cosmetic superiority. Mean operation times were equal to both group in unilateral repair (28+/-9 m for LPC vs 29+/-17 for C-D), and shorter for LPC in bilateral repair (38+/-14 vs 47+/-20). Postoperative hernia recurrence was less in LPC (0.1% vs 0.5% of total PPVs). Contralateral hernia developed less in LPC (0.8% vs 1.3 % of unilateral PPV closure). Postoperative direct hernia occurred in one patient of group C-D (0.3%). Group C-D had injuries to reproductive systems during the operation in two patients (0.7%).
Conclusion: Our technique has succeeded to reduce the rates of postoperative hernia recurrence and contralateral hernia and the risk of injuries to reproductive systems.


Session: Podium Presentation

Program Number: S045

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