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Chen AL, Wilhelm S, Sobolic M, Brahmamdam P, Akay B, Novotny NM. Laparoscopic Repair of Pediatric Femoral Hernias. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38442225 DOI: 10.1089/lap.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background: Current rates of reported pediatric femoral hernias remain exceedingly low, with their incidence reported to be <1%. The mainstay of repair has traditionally been through an open approach, and pediatric surgeons remain reluctant to repair otherwise. Owing to its rarity, consensus regarding management remains absent. Because of this, we present a scoping review on the use of laparoscopy and minimally invasive techniques to repair pediatric femoral hernias. Methods: A scoping literature review was performed using PubMed, Embase, Scopus, and Web of Science for related articles (keywords). Full-text articles and abstracts were then reviewed for relevance using inclusion and exclusion criteria with data extracted from each piece. Results: The search identified 268 articles published from 1992 to 2023. Eleven articles met our inclusion criteria. After reviewing their content, a total of 87 patients were identified. Of these, 42 laparoscopic repairs were reported. Three primary laparoscopic surgical techniques were described, with no recurrence reported. Conclusion: Laparoscopy remains a viable tool in diagnosing and managing femoral hernias. Various technically feasible options for laparoscopy and minimally invasive techniques have been described with excellent results and limited recurrence. However, given the quality of the data, further studies are needed to investigate the long-term durability of such repairs.
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Affiliation(s)
- Alexander L Chen
- Department of General Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Spencer Wilhelm
- Department of General Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Michael Sobolic
- Department of General Surgery, Corewell Health East-William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Pavan Brahmamdam
- Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
| | - Begum Akay
- Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
| | - Nathan M Novotny
- Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan, USA
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Fukahori S, Sakamoto S, Hashizume N, Masui D, Higasidate N, Tsuruhisa S, Nakahara H, Koga Y, Saikusa N, Ishii S, Tanaka Y, Yagi M. Laparoscopic identification of combined pediatric femoral hernia and ruptured abdominal cyst of the canal of Nuck: A report of an extremely rare case. Asian J Endosc Surg 2021; 14:557-560. [PMID: 32924249 DOI: 10.1111/ases.12866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
A 7-year-old girl was referred to our hospital with a suspected right-sided indirect inguinal hernia. An egg-sized elastic, non-painful mass was palpated in the right inguinal region. Preoperative CT demonstrated a 30-mm simple cystic mass in the right internal inguinal canal, which we diagnosed as an abdominal cyst of the canal of Nuck. Laparoscopy revealed that the abdominal cystic component was ruptured, so we performed Pott's procedure. However, the patient's right groin swelled on postoperative day 3, necessitating re-operation. The patient's symptoms recurred again after 3 months, despite having had two surgical repairs. In the third operation, a right-sided femoral hernia was confirmed and repaired via external and laparoscopic approaches. To the best of our knowledge, there have been no reports on the combination of femoral hernia and cyst of the canal of Nuck in children. A laparoscopic approach was useful for obtaining a definitive diagnosis and conducting a safe and secure surgical repair.
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Affiliation(s)
- Suguru Fukahori
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Saki Sakamoto
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Naoki Hashizume
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Daisuke Masui
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Naruki Higasidate
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shiori Tsuruhisa
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hirotomo Nakahara
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoshinori Koga
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Nobuyuki Saikusa
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shinji Ishii
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoshiaki Tanaka
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan.,Division of Medical Safety Management, Kurume University School of Medicine, Kurume, Japan
| | - Minoru Yagi
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
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Haggui B, Hidouri S, Ksia A, Mosbahi S, Messaoud M, Sahnoun L, Mekki M, Belghith M, Nouri A. Femoral hernia in children: How to avoid misdiagnosis? Afr J Paediatr Surg 2021; 18:164-167. [PMID: 34341202 PMCID: PMC8362919 DOI: 10.4103/ajps.ajps_74_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Femoral hernias are an uncommon groin pathology among pediatric patients. Therefore, they are frequently misdiagnosed. In the present study, we review our experience with this rare surgical entity during the past 25 years. METHODS The medical records of 19 patients who underwent 22 femoral hernia repairs between January 1994 and December 2019 were retrospectively analysed. RESULTS Patients' age ranged from 2 to 12 years (mean age was 5. 5 years) with an approximately equal sex ratio (10 girls/9 boys). There were three bilateral cases identified separately. They were discovered and managed at different times. All the children were referred with a groin lump, but the correct pre-operative diagnosis was made in only 13 cases (59%). In the remaining cases, four were identified intraoperatively following negative exploration for a supposed inguinal hernia. The other five were found to have a femoral hernia 1 month to 12 months after ipsilateral inguinal hernia repair. All patients underwent elective surgery. The femoral canal was closed using either Lytle or McVay procedure. Recurrence occurred in only one patient 2 months after initial repair. CONCLUSION Femoral hernias are often misdiagnosed. Pre-operative diagnosis can be obtained through careful clinical assessment. In equivocal cases, ultrasonography and laparoscopy could be useful. A correct pre-operative diagnosis will lead to suitable treatment, thus avoiding unnecessary reoperations and their related complications.
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Affiliation(s)
- Basma Haggui
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Saida Hidouri
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Amine Ksia
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Sana Mosbahi
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Marwa Messaoud
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Lassaad Sahnoun
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Mongi Mekki
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Mohsen Belghith
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
| | - Abdellatif Nouri
- Department of Pediatric Surgery, Medical School of Monastir, Fattouma Bourguiba Hospital, Monastir University, Research Laboratory LR12SP13, Tunisia
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Aneiros Castro B, Cano Novillo I, García Vázquez A, López Díaz M, Benavent Gordo MI, Gómez Fraile A. Pediatric femoral hernia in the laparoscopic era. Asian J Endosc Surg 2018; 11:233-237. [PMID: 29266814 DOI: 10.1111/ases.12448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Femoral hernia is a rare and often misdiagnosed condition in childhood. The aim of our study was to demonstrate that the laparoscopic approach improves diagnostic accuracy and offers a safe and effective treatment. METHODS A retrospective study of 687 pediatric patients who underwent laparoscopic inguinal hernia repair from January 2000 to December 2015 was performed. RESULTS Femoral hernias were identified in 16 patients (2.3%). The right side was affected in 10 cases (62.5%), the left side in 5 (31.2%), and 1 case was bilateral (6.2%). The mean age of patients was 8.00 ± 3.81 years, and there was a male predominance. Preoperative diagnosis was femoral hernia in eight cases (50%) and indirect inguinal hernia in the remaining eight (50%). Seven children (43.8%) presented with hernia recurrence after having undergone an open ipsilateral indirect hernia repair. A modified laparoscopic McVay technique was performed in 12 cases (70.6%). An epigastric artery injury by trocar occurred in one patient. All operations were completed laparoscopically. The mean surgical time was 45.6 ± 22.9 min for unilateral cases and 110 ± 10.0 min for bilateral cases. No immediate postoperative complications were noted. The mean postoperative hospital stay was 0.6 ± 0.4 days. No recurrence was observed after a median follow-up of 11 years (range, 4-16 years). CONCLUSION Femoral hernia is a rare pathology in pediatric patients that is often difficult to diagnose. The laparoscopic approach is effective in the diagnosing and treating these hernias, and it allows for the simultaneous repair of multiple groin defects.
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Affiliation(s)
| | | | | | - María López Díaz
- Department of Pediatric Surgery, 12 October Hospital, Madrid, Spain
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Single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia in children and adolescents: case series. Hernia 2017; 21:443-447. [PMID: 28197793 PMCID: PMC5435792 DOI: 10.1007/s10029-017-1573-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 01/05/2017] [Indexed: 10/30/2022]
Abstract
BACKGROUND Femoral hernias are an often unexpected groin pathology during childhood. However, the pediatric surgeon has to be aware to diagnose femoral hernia and to repair this condition. This is the first report on laparoscopic percutaneous extraperitoneal closure of femoral hernia (LPEF) in children and adolescents. METHODS Over a 6-year period in a bi-institutional clinical study, we retrospectively identified six children and one young adult who underwent LPEF repair. RESULTS Femoral hernia was laparoscopically confirmed in seven patients. Ages at surgery were 3, 5, 7, 7, 8, 8.5, and 18 years, respectively. In the first case, we combined laparoscopic diagnosis with open repair. In the consecutive six cases, hernias were repaired minimally invasively with the percutaneous extraperitoneal technique described below. During a follow-up between 6 years and 6 months, no recurrence was observed. SURGICAL TECHNIQUE For LPEF, we percutaneously placed a peritoneal U-shape suture with integrated transfixation of the hernia sac, closed with an epifascial knot. We performed LPEF using two graspers. The peritoneum was percutaneously punctured with a venous cannula through which the suture was inserted. One grasper was inserted through the working channel of the laparoscope to invert the hernia sac into the abdominal cavity. A mini-grasping forceps inserted through the cannula retrieved the thread and completed LPEF. CONCLUSION We demonstrate that single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia is successful and quick in children and in adolescents.
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Tan SY, Stevens MJ, Mueller CM. A Novel Laparoscopic-Assisted Approach to the Repair of Pediatric Femoral Hernias. J Laparoendosc Adv Surg Tech A 2013; 23:946-8. [DOI: 10.1089/lap.2013.0199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Serena Y. Tan
- Department of Surgery, Stanford Hospital and Clinics, Stanford, California
| | - Megan J. Stevens
- Division of Pediatric General Surgery, Lucile Packard Children's Hospital, Stanford, California
| | - Claudia M. Mueller
- Division of Pediatric General Surgery, Lucile Packard Children's Hospital, Stanford, California
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Lukish JR. Regarding: Laparoscopic-assisted femoral hernia repair in children. J Laparoendosc Adv Surg Tech A 2010; 20:509. [PMID: 20565306 DOI: 10.1089/lap.2009.0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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