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Surgical Endoscopy

, Volume 21, Issue 8, pp 1327–1331 | Cite as

Subcutaneous endoscopically assisted ligation (SEAL) of the internal ring for repair of inguinal hernias in children: report of a new technique and early results

  • D. Ozgediz
  • K. Roayaie
  • H. Lee
  • K. K. Nobuhara
  • D. L. Farmer
  • B. Bratton
  • M. R. Harrison
Article

Abstract

Background

Open inguinal hernia repair with high ligation is an excellent method of repair in the pediatric population. Advantages of endoscopic repairs include the ability to evaluate the contralateral side, avoidance of access trauma to the vas deferens and gonadal vessels, and decreased operative time. We now report our experience with subcutaneous endoscopically assisted ligation (SEAL), a novel technique that has proved to be a safe and effective in the treatment of inguinal hernia in the pediatric population.

Methods

The study is based on a retrospective review of 204 pediatric patients with 300 inguinal hernias treated with the SEAL technique from November 2001 to August 2003 at a tertiary referral center. Patient age ranged from 30 days to 16 years at the time of operation, with a mean follow-up of 235 days (median follow-up, 189 days). Statistical analysis was done with χ2 test, with the main outcome measures being intraoperative and postoperative complications including recurrence rate, suture abscesses, and postoperative hydroceles.

Results

There were 13 recurrences in 300 SEAL repairs, for a recurrence rate of 4.3% (95% C.I. 2.01%–6.65%), with only two recurrences in the last 100 repairs (2%). There were 10 suture abscesses or granulomas and 7 postoperative hydroceles. There was no statistically significant association between recurrence and gender, age at operation, history of prematurity, bilaterality, or kind of suture used.

Conclusions

Our 4.3% (95% C.I. 2.01–6.65%) recurrence rate is comparable to prior series of laparoscopic repairs citing recurrence rates of 0%–5.7%. The majority of recurrences occurred within the first 4 months of developing this new procedure, with only two recurrences in the last 100 repairs. These pilot data suggest that SEAL is a safe and effective technique for inguinal hernia repair in the pediatric population. A prospective study is planned to compare this laparoscopic technique with open herniorrhaphy.

Keywords

Inguinal hernia Endoscopic ligation Pediatric population 

Notes

Acknowledgments

We thank Tiffany Townsend for valuable discussions and contribution to the literature review. We also thank Anita Kris for assistance with data entry and Vilma Zarate for assistance with figures and final manuscript preparation.

References

  1. 1.
    Antao B, Samuel M, Curry J, Kiely E, Drake D (2004) Comparative evaluation of laparoscopic vs. open inguinal herniotomy in infants. J Laparoendoscopic Adv Surg Tech 8: 302–309Google Scholar
  2. 2.
    DuBois JJ, Jenkins JR, Egan JC (1997) Transinguinal laparoscopic examination of the contralateral groin in pediatric herniorrhaphy. Surg Laparosc Endosc 7: 384–387PubMedCrossRefGoogle Scholar
  3. 3.
    Gorsler CM, Schier F (2003) Laparoscopic herniorrhaphy in children. Surg Endosc 17: 571–573PubMedCrossRefGoogle Scholar
  4. 4.
    Grossmann PA, Wolf SA, Hopkins JW, Paradise NF (1995) The efficacy of laparoscopic examination of the internal inguinal ring in children. J Pediatr Surg 30: 214–217; discussion 217–218PubMedCrossRefGoogle Scholar
  5. 5.
    Lobe TE, Schropp KP (1992) Inguinal hernias in pediatrics: initial experience with laparoscopic inguinal exploration of the asymptomatic contralateral side. J Laparoendosc Surg 2: 135–140; discussion 141PubMedGoogle Scholar
  6. 6.
    Miltenburg DM, Nuchtern JG, Jaksic T, Kozinetiz C, Brandt ML (1998) Laparoscopic evaluation of the pediatric inguinal hernia—a meta-analysis. J Pediatr Surg 33: 874–879PubMedCrossRefGoogle Scholar
  7. 7.
    Montupet P, Esposito C (1999) Laparoscopic treatment of congenital inguinal hernia in children. J Pediatr Surg 34: 420–423PubMedCrossRefGoogle Scholar
  8. 8.
    Pellegrin K, Bensard DD, Karrer FM, Meagher DP Jr. (1996) Laparoscopic evaluation of contralateral patent processus vaginalis in children. Am J Surg 172: 602–605; discussion 606PubMedCrossRefGoogle Scholar
  9. 9.
    Perlstein J, Du Bois JJ (2000) The role of laparoscopy in the management of suspected recurrent pediatric hernias. J Pediatr Surg 35: 1205–1208PubMedCrossRefGoogle Scholar
  10. 10.
    Prasad R, Lovvorn HN 3rd, Wadie GM, Lobe TE (2003) Early experience with needleoscopic inguinal herniorrhaphy in children. J Pediatr Surg 38: 1055–1058PubMedCrossRefGoogle Scholar
  11. 11.
    Rescorla FJ, West KW, Engum SA, Scherer LR 3rd, Grosfeld JL (1997) The “other side” of pediatric hernias: the role of laparoscopy. Am Surg 63: 690–693PubMedGoogle Scholar
  12. 12.
    Rogers DA, Hatley RM, Howell CG Jr (1998) A prospective, randomized comparison of traditional and laparoscopic inguinal exploration in children. Am Surg 64: 119–121PubMedGoogle Scholar
  13. 13.
    Rowe MI, Copelson LW, Clatworthy HW (1969) The patent processus vaginalis and the inguinal hernia. J Pediatr Surg 4: 102–107PubMedCrossRefGoogle Scholar
  14. 14.
    Schier F (1998) Laparoscopic herniorrhaphy in girls. J Pediatr Surg 33: 1495–1497PubMedCrossRefGoogle Scholar
  15. 15.
    Schier F (2000) Laparoscopic surgery of inguinal hernias in children—initial experience. J Pediatr Surg 35: 1331–1335PubMedCrossRefGoogle Scholar
  16. 16.
    Schier F, Danzer E, Bondartschuk M (2001) Incidence of contralateral patent processus vaginalis in children with inguinal hernia. J Pediatr Surg 36: 1561–1563PubMedCrossRefGoogle Scholar
  17. 17.
    Schier F, Montupet P, Esposito C (2002) Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs. J Pediatr Surg 37: 395–397PubMedCrossRefGoogle Scholar
  18. 18.
    Shalaby R, Desoky A (2002) Needlescopic inguinal hernia repair in children. Pediatr Surg Int 18: 153–156PubMedCrossRefGoogle Scholar
  19. 19.
    Stylianos S, Jacir NN, Harris BH (1993) Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg 28: 582–583PubMedCrossRefGoogle Scholar
  20. 20.
    Tackett LD, Breuer CK, Luks FI, Caldamone AA, Breuer JG, DeLuca FG, Caesar RE, Efthemiou E, Wesselhoeft CW Jr (1999) Incidence of contralateral inguinal hernia: a prospective analysis. J Pediatr Surg 34: 684–687; discussion 687–688PubMedCrossRefGoogle Scholar
  21. 21.
    Weber R, Trazy T, Keller M (2005) Groin hernias and hydroceles. In: Ashcraft K, Holcomb G, Murphy J (eds), Pediatric Surgery, 4th Edition, Mosby-Yearbook, St. Louis MOGoogle Scholar
  22. 22.
    Wulkan ML, Wiener ES, VanBalen N, Vescio P (1996) Laparoscopy through the open ipsilateral sac to evaluate presence of contralateral hernia. J Pediatr Surg 31: 1174–1176; discussion 1176–1177PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • D. Ozgediz
    • 1
  • K. Roayaie
    • 1
  • H. Lee
    • 1
  • K. K. Nobuhara
    • 1
  • D. L. Farmer
    • 1
  • B. Bratton
    • 1
  • M. R. Harrison
    • 1
  1. 1.Division of Pediatric Surgery, Department of SurgeryUniversity of CaliforniaSan FranciscoUSA

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