A single institution experience with Laparoscopic Hernia repair in 791 children

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

Effectiveness of preoperative ultrasonography in predicting metachronous contralateral inguinal hernia in children: a single-arm prospective study using a historical control for comparison

PURPOSE

To analyze the value of ultrasonography in predicting metachronous contralateral inguinal hernia (MCIH) and diagnosing contralateral persistent processus vaginalis (CPPV) in children with unilateral inguinal hernia, a prospective study was conducted.

METHODS

All participants underwent a preoperative ultrasound on the contralateral groin. Patients in group A1 received operating procedure according to ultrasound results (patients with negative contralateral US results received hernia repair on the affected side), and patients in group A2 received operation according to laparoscopic results (patients received hernia repair and CPPV ligation). All patients were followed up 2 years and compared to a historical control (group B) who underwent open hernia repair only on the affected side regardless of contralateral US results.

RESULTS

In groups A1 and A2, laparoscopic exploration revealed the presence of a CPPV in 490 cases. Ultrasound was found to be accurate in 104 out of the 490 cases with four false-positive and 386 false-negative results. This yielded an accuracy of 59.3%, a sensitivity of 21.2%, and a specificity of 99.2%. 10 patients in group A1, and 74 patients in group B developed MCIH. The accuracy, sensitivity, and specificity of the value of ultrasonography in predicting MCIH were 89.3%, 52.4%, and 92.5%, respectively.

CONCLUSIONS

Preoperative ultrasonography of the contralateral groin is currently unable to accurately detect CPPV, but it appears to be a promising method in predicting MCIH by using rigorous diagnosing criteria.

Laparoscopic hernia repair in children: does recreating the open operation improve outcomes? A systematic review

PURPOSE

The use of laparoscopy for paediatric inguinal hernia repairs has increased significantly over the past 2 decades. However, there is significant variation in the reported recurrence rates in the literature, with many studies reporting higher rates than the open operation. This may be explained by the range of different techniques currently included under the term laparoscopic inguinal hernia repair. The purpose of this study is to determine whether dividing the hernia sac before ligation improves surgical outcomes following a paediatric laparoscopic inguinal hernia repair compared to ligation alone.

METHODS

A systematic review of the literature was performed following PRISMA guidelines of all studies reporting the outcomes following paediatric laparoscopic inguinal hernia repair where the technique was recorded as laparoscopic suture ligation alone (LS) or laparoscopic sac division and suture ligation (LSDS). Studies were assessed for risk of bias and exclusion criteria included reported follow-up of less than 6 months.

RESULTS

A total of 8518 LS repairs and 6272 LSDS repairs were included in the final analysis. LSDS repair was associated with a significantly lower recurrence rate (odds ratio 0.51, 95% CI 0.36-0.71, p = 0.001). There was no significant difference in the rates of testicular ascent or atrophy.

CONCLUSION

Recreating the open operation by hernia sac division followed by suture ligation significantly reduces the risk of hernia recurrence.

Laparoscopic Repair of an Incarcerated Left Ovary, Hemi-Uterus, and Salpinx Within A Left Inguinal Hernia

Inguinal hernia repair is one of the most common operations performed by pediatric surgeons. These hernias typically present as asymptomatic or symptomatic swellings in the groin, extending into the labia in girls or the scrotum in boys. Surgical repair is indicated as these hernias do not spontaneously close and carry a risk of incarceration. We report a case of an extremely rare finding at the time of laparoscopic inguinal hernia repair in a preteen girl, highlighting the variable clinical presentation of this common condition and the laparoscopic approach to repair.

Laparoscopic inguinal herniotomy: Recreating the open operation optimises outcomes

BACKGROUND

Recent evidence suggests simple laparoscopic inguinal herniorrhaphy is associated with higher rates of recurrence and testicular ascent. We instigated a standardised approach to laparoscopic inguinal herniotomy (LIH), with circumferential sac division and 'purse-string' closure (4/0 monofilament polypropylene). An active follow-up programme was pursued. We reviewed our outcomes of this technique and compared them to an open herniotomy (OIH) cohort.

METHODS

LIH patients were identified prospectively (2017-2021): OIH retrospectively from 2016. Risk factors for complications were defined: extremely to very preterm (< 32 weeks), emergency presentation with incarceration, and redo surgery for recurrence. Data are presented as median [IQR]. Comparisons used Fisher's exact and Mann-Whitney U tests: significance defined as p < 0.05.

RESULTS

192 inguinal herniae in 140 patients were included in the LIH group and 214 herniae in 179 patients in the OIH group. Groups were similar in age and gender. The LIH group had a significantly larger proportion of cases that were premature, had emergency surgery, or had redo surgery after previous OIH. Follow-up was 24.4 months [10.8-33.6] vs. 66.4 [64.5-68.5] (LIH vs. OIH). Hernia recurrence occurred in 2/192 (1.0%) vs. 4/214 (1.9%) (LIH vs. OIH), p = 0.69. There was one known case of testicular ascent after OIH but none in the LIH group.

CONCLUSIONS

Recreation of the open herniotomy laparoscopically appears to confer excellent outcomes, with low rates of recurrence despite a high proportion of patients having known risk factors. Further long-term data on rates of testicular ascent after active follow-up are required.

Percutaneous Internal Ring Suturing is a Safe and Effective Method for Inguinal Hernia Repair in Young Adolescents

Background: Percutaneous internal ring suturing (PIRS) is a laparoscopic procedure that has demonstrated its safety and efficacy as a method of hernia repair in younger children but without evidence among the adolescent population. The aim of this study was to determine the success of PIRS outcomes for hernia repair in the adolescent population. Methods: All adolescents who were operated on using the PIRS method for inguinal repair during the 5-year study period in a single center were included in a prospective cohort study. The main outcome of the study included treatment outcomes in a term of recurrence rate. The secondary outcomes include other treatment outcomes such as complications, conversion to an open procedure, and reoperation rates, as well as duration of anesthesia and surgery, duration of hospital admission, and the level of carbon dioxide pneumoperitoneum. Results: In 51 adolescents (72.5% males) with a median age of 13 years and median follow-up of 44 months, a total of 57 PIRS procedures were performed. There were 30 (58.8%) right hernia repairs, 15 (29.4%) left hernia repairs, and 6 (11.8%) bilateral hernia repairs. The median surgical time was 10 minutes for unilateral and 18 minutes for bilateral hernia repair. The median length of hospital stay was 24 hours. Only one (1.95%) intraoperative complication occurred during surgery, an inferior epigastric vein injury. No complications or recurrences were observed during the follow-up period. Conclusions: PIRS has proven to be simple, safe, and effective method for groin hernia repair in adolescent population. This method provides excellent overall and cosmetic outcomes. There is a low incidence of complications and recurrences. According to our results, PIRS could be considered to become a possible approach for groin hernia repair in adolescents.