Laparoscopic Inguinal Hernia Repair in Children with Transperitoneal Division of the Hernia Sac.

INTRODUCTION: This case series reviews the results of our new, modified technique for repair of inguinal hernias (IH) in children.
METHODS: This is a retrospective case series of one surgeon during the period of January to August 2007. A total of 32 IH were repaired laparoscopically in 28 patients (5 girls, 23 boys, median age 3 years, range 1 month to 14 years). 22 children had unilateral IH, 5 had bilateral IH, and 1 child had no IH. One 3 mm incision was made at the umbilicus for a one-step camera port. Two 2 mm incisions were made on either side of the umbilicus for working instruments without ports. The peritoneum of the hernia sac was circumferentially divided around the internal inguinal ring and was dissected away from the vas deferens and spermatic cord vessels. The peritoneum was then closed intracorporeally using a 4-0 vicryl pursestring suture, completing the herniotomy.
RESULTS: Mean operating time for unilateral IH repairs was 46.2 minutes (SD +/- 9.8). Mean operating time for bilateral IH repairs was 67 minutes (SD +/- 12.8). There were no intraoperative complications. Two patients (7%) with a preoperative diagnosis of a unilateral IH were found to have bilateral IH upon laparoscopic exam. Postoperative pain was minimal to none in 25 patients (93%) up to discharge. All patients were discharged to home the same day of surgery. All patients returned to their normal activity within 24 hours. Follow-up to date is 1-8 months. There were no IH recurrences, nor was there any documentation of persistent hydroceles.
CONCLUSION: Laparoscopic IH repair with circumferential division of the hernia sac and pursestring closure of the peritoneum shows good short-term results. The surgical time is comparable to historical controls in open surgery. Children tolerate the laparoscopic procedure well, and studies show the pain to be less than with an open approach. Other laparoscopic techniques have recurrence rates reported as high as 4.1%. We have no recurrences thus far, but a longer follow-up will be necessary in order to assess the longevity of this repair.

Session: Poster

Program Number: P348

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