Variation in the use of laparoscopy with inguinal hernia repairs in a sample of pediatric patients at children's hospitals

Comparison of laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure versus open repair for pediatric inguinal hernia

Background

Laparoscopic-assisted repairs for pediatric inguinal hernia have gained gradual acceptance over the past decade. However, consensus about the optimal management is still lacking. The aim of this study is to compare outcomes of a modified laparoscope-assisted single-needle laparoscopic percutaneous extraperitoneal closure (LPEC) versus open repair of pediatric hernias/hydrocele in a single institution.

Materials and methods

We retrospectively reviewed the medical data of children who underwent laparoscope-assisted single-needle LPEC and open repair (OR) for inguinal hernia from 2014 to 2019. Data collection included demographics, laterality of hernia, surgical time and time to follow-up. We also reviewed and analyzed the evidence of recurrence, the incidence of metachronous contralateral inguinal hernia (MCIH), and other complications.

Results

In our cohort, 961 patients in the OR group and 1098 patients in the LPEC group were analyzed retrospectively. Mean operative time was significantly shorter in the LPEC group (22.3 ± 3.5 min) than in the OR group (27.8 ± 5.9 min) for bilateral hernia repair (p < 0.001). Postoperative recurrence was 1.3% (13/1035) in the OR group and 0.5% (6/1182) in the LPEC group (p = 0.056). Iatrogenic cryptorchidism occurred statistically more frequently in the OR group than in the LPEC group (0.4% vs. 0%, p = 0.013). In addition, the incidence of MCIH was 3.7% (33/887) in the OR group and 0.3% (3/1014) in the LPEC group (p < 0.01).

Conclusion

Comparing to open technique, laparoscope-assisted single-needle LPEC provides a simple and effective option for pediatric inguinal hernia/hydrocele repair with excellent outcomes, a low incidence of recurrence, and reduced MCIH.

Pediatric inguinal hernia treated by single-port laparoscopic water injection hernia crochet needle

Introduction

Inguinal hernia is the most common disease in pediatric surgery and is induced by congenital processus vaginalis patency. Almost all inguinal hernias are inguinal indirect hernias, and herniorrhaphy has accounted for about 15% of all pediatric operations. In the past 20 years, with the development of minimally invasive technology, laparoscopic inguinal herniorrhaphy has been emerging in China and in other countries.

Aim

To introduce a new technique for treating inguinal hernia in children, and evaluate the feasibility and surgical efficacy of a transumbilical single-port laparoscopic water-injection hernia crochet needle in treating pediatric inguinal hernia.

Material and methods

Clinical data of 136 inguinal hernial children treated using a transumbilical single-port laparoscopic water-injection hernia crochet needle in our hospital from June 2017 to December 2018 were retrospectively analyzed.

Results

All procedures were successfully accomplished, and no case was converted to a different procedure; the average operation time was 16 min for one side and 35 min for both sides. Patients were followed for an average of 10 months after surgery. One patient had a line-knot reaction at the inguinal puncture point 3 months after surgery and recovered after conservative treatment, and no recurrent case was observed after surgery.

Conclusions

It is feasible to treat pediatric inguinal hernia through a transumbilical single-port laparoscopic water-injection hernia crochet needle, which is associated with safety, less trauma, rapid recovery, no obvious scar, and satisfactory efficacy. Therefore, it is worthy of being promoted and applied in clinical practice.