Laparoscopic inguinal hernia repair in children: Article review and the preliminary Maltese experience

Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children

INTRODUCTION

Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method.

METHODS

Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared.

RESULTS

The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time (p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients.

CONCLUSIONS

PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.

Percutaneous Internal Ring Suturing for Inguinal Hernia Repair in Children: Retrospective Cohort of 714 Patients with Minimum 3-Year Follow-Up

Background and Objectives: Despite numerous described techniques, laparoscopy has yet to replace open surgery as the gold standard for inguinal hernia (IH) repair in children. This may be due to many variables, including the lack of long-term follow-up and concern for increased recurrence. In this study, we present our long-term follow-up data on children undergoing percutaneous internal ring suturing (PIRS) for IH repair. Materials and Methods: This retrospective cohort study included children who underwent PIRS for IH between May 2013 and May 2021 at three tertiary care institutions, with at least three years of follow-up. Age at surgery, side of IH, presence of contralateral patent processus vaginalis, surgical and anesthesia time, and complications were noted. Parents were contacted to enquire about long-term complications, such as recurrence. Results: Long-term follow-up (average 6.9 ± 2.3 years) was available for 714 patients. For unilateral and bilateral procedures, the average surgical time was 13.6 ± 5.4 and 19.9 ± 3.0, and the average anesthesia time was 27.7 ± 12.9 and 33.9 ± 14.1 min, respectively. Complications were seen in 0.84% of patients and 1.2% of procedures, and recurrence was observed in 0.98% of patients and 0.78% of procedures. Conclusions: Our study, with a nearly 7-year follow-up, provides substantial evidence that PIRS is a safe and effective technique for IH repair in children, with low recurrence and complication rates. Despite the study's retrospective nature and limited sample size, it contributes valuable data supporting the use of PIRS in pediatric IH repair.

Single-Port Laparoscopic Extraperitoneal Repair of Pediatric Inguinal Hernias and Hydroceles by Using Hernia Crochet Needle With a Cannula

PURPOSE

Numerous modifications laparoscopic techniques have mushroomed in recent years. Here we describe a modified technique of extracorporeal ligation of processus vaginalis in children using a hernia crochet needle with a cannula.

METHODS

Processus vaginalis repair was carried out on patients diagnosed with inguinal hernia or hydroceles using this novel technique between June 2021 and June 2022. The processus vaginalis was closed extracorporeally using a hernia crochet needle with a cannula. In the presence of patent processus vaginalis, the same procedure would be performed on the contralateral side. The primary outcomes was the safety and efficiency of this modified procedure, and the secondary outcomes was the post operative complications.

RESULTS

A total of 212 (165 inguinal hernia and 47 hydroceles) children were corrected by this novel technique. The mean operation time was 27.49 min for unilateral inguinal hernia cases and 36.55 min for bilateral cases. The unilateral hydrocele median operation time was 27.83 min and that for the bilateral cases was 37.30 min. During the mean of 10.92 months of follow-up, there was only a boy subject to a metachronous contralateral occurrence of hernia 10 months after surgery, and no other complications (knot reactions, testicular atrophy, postoperative hydrocele or iatrogenic) have been observed yet.

CONCLUSION

This study shown a unique procedure with using a hernia crochet needle with a cannula to be simple, safe, and effective in managing inguinal hernias and hydroceles in the pediatric population.

Percutaneous Internal Ring Suturing for the Minimally Invasive Repair of Congenital Inguinal Hernia in Neonates: A Retrospective Cohort Study

Introduction Inguinal hernia (IH) repair is among the most frequently performed surgical operations in children. While open herniorrhaphy has been the gold standard surgical method of choice, the popularity of laparoscopic repair has sharply risen over the past two decades. Although a wide range of literature on the use of laparoscopy for IH repair in children exists, data regarding neonates, an especially delicate group of children, is limited to only a few studies. This study aims to evaluate the surgical, anaesthetic, and follow-up data of term neonates undergoing percutaneous internal ring suturing (PIRS) for IH repair in order to determine if it is a viable option for this specific patient population. Materials and methods This single-centre retrospective cohort included all children who underwent PIRS for IH repair during an 86-month period between October 2015 and December 2022. Patients' gender, gestational age at birth, age and weight at surgery, side of IH at diagnosis, per-operative findings (presence of contralateral patent processus vaginalis (CPPV)), surgical time, time under anaesthesia, follow-up time, and follow-up findings were collected from an electronic database and analysed. The primary outcome measures were surgical time, rate of recurrence, and presence of CPPV and the secondary outcome measures were anaesthesia time and the rate of complications. Results During the study period, 34 neonates (23 male and 11 female) underwent laparoscopic repair for IH using the PIRS technique. Average age and weight at surgery were 25.2 ± 3.2 (20-30) days and 3530.4 ± 293.6 (3012 - 3952) gm, respectively. IH was detected on the right side in 19 (55.9%), on the left side in 12 (35.3%), and bilaterally in three (8.8%) patients at their presenting physical examination. Nine patients (26.5%) were found to have CPPV perioperatively, which were all repaired simultaneously. The average surgical time was 20.3 ± 4.5 minutes for unilateral and 25.8 ± 4.0 minutes for bilateral IH repair (p<0.01). On the contrary, the average time under anaesthesia was 33.2 ± 4.5 minutes for unilateral and 33.5 ± 4.9 minutes for bilateral IH repair, but the difference was not statistically significant (p>0.05). No early postoperative complications were observed. The average follow-up time was 27.6 ± 14.4 (range: 3-49) months. Recurrence was seen in one patient (2.9%) and umbilical incision granuloma was observed in two (5.9%) patients. Conclusion Surgical times, anaesthesia times, complication rates, recurrence rates, and rate of CPPV in neonates undergoing PIRS are similar to those in older children and comparable to those of open herniorrhaphy and other laparoscopic techniques. Despite the suspicion that the rate of CPPV would be higher in neonates, we found that it is similar to that in older children. We conclude that PIRS is a viable option for the minimally invasive repair of IH in neonates.