Advertisement

Surgical Endoscopy

, Volume 29, Issue 4, pp 781–786 | Cite as

Laparoscopic needle-assisted inguinal hernia repair in 495 children

  • Lauren McClain
  • Christian Streck
  • Aaron Lesher
  • Robert Cina
  • Andre Hebra
Article

Abstract

Minimally invasive surgery for inguinal hernia repair in children has been a controversial topic for pediatric surgeons. Our method for inguinal hernia repair using laparoscopic techniques has comparable outcomes to the standard open technique. We describe our technique and experience with the laparoscopic needle-assisted repair of inguinal hernia (LNAR). We report 502 cases (710 hernias) from 2009 to 2013 by 3 surgeons. We reviewed our prospectively collected outcomes database of all patients receiving LNAR from 1/2009 to 3/2013. 502 cases in 495 patients <13 years old with 710 inguinal hernias were identified for analysis and review. Hernia repair is accomplished with a single-port needle-assisted technique. After identification of a patent processus vaginalis, the internal ring is encircled in an extraperitoneal plane using a 22G-Touhy needle for placement of a purse-string suture, tied extracorporally, and buried beneath the skin. The technique was standardized for all cases. 710 inguinal hernias were laparoscopically repaired in 495 patients (408 boys and 87 girls) age range 11 days to 12.8 years (mean 29.2 months; median 15.5 months). 294 patients had unilateral repair (199R and 95L) and 208 had bilateral repair. Mean operating time for unilateral was 20.5 min, and bilateral was 26.4 min. 21 minor complications were identified (9 superficial wound infections, 8 suture granulomas, and 4 recurrent hydroceles) and 4 recurrences. Mean time since surgery is 30 months (3–54 months). Mean follow-up was 10.7 months (0.3–38.4 months). Post-operative data show our technique is safe with a 4 % rate of minor complication. Recurrence rate was 0.56 % for the total number of hernias (4/710). This recurrence rate is comparable and in many cases less than open technique. Furthermore, laparoscopy objectively identifies asymptomatic or occult contralateral defect, uses a smaller incision, and eliminates dissection of the cord structures potentially reducing the risk of cord injury.

Keywords

Pediatrics Hernia Laparoscopic Inguinal 

Notes

Disclosures

Drs. Lauren McClain, Christian Streck, Aaron Lesher, Robert Cina, and Andre Hebra have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Ein SH, Njere I, Ein A (2006) Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 41(5):980–986CrossRefPubMedGoogle Scholar
  2. 2.
    Saad S, Mansson J, Saad A, Goldfarb MA (2011) Ten-year review of groin laparoscopy in 1001 pediatric patients with clinical unilateral inguinal hernia: an improved technique with transhernia multiple-channel scope. J Pediatr Surg 46(5):1011–1014CrossRefPubMedGoogle Scholar
  3. 3.
    Chan KL, Hui WC, Tam PK (2005) Prospective randomized single-center, single-blind comparison of laparoscopic vs open repair of pediatric inguinal hernia. Surg Endosc 19(7):927–932CrossRefPubMedGoogle Scholar
  4. 4.
    Bharathi RS, Dabas AK, Arora M, Baskaran V (2008) Laparoscopic ligation of internal ring-three ports versus single-port technique: are working ports necessary? J Laparoendosc Adv Surg Tech A. 18(6):891–894CrossRefPubMedGoogle Scholar
  5. 5.
    Koivusalo AI, Korpela R, Wirtavuori K, Piiparinen S, Rintala RJ, Pakarinen MP (2009) A single-blinded, randomized comparison of laparoscopic versus open hernia repair in children. Pediatrics 123(1):332–337CrossRefPubMedGoogle Scholar
  6. 6.
    Schier F (2006) Laparoscopic inguinal hernia repair-a prospective personal series of 542 children. J Pediatr Surg 41(6):1081–1084CrossRefPubMedGoogle Scholar
  7. 7.
    Treef W, Schier F (2009) Characteristics of laparoscopic inguinal hernia recurrences. Pediatr Surg Int 25(2):149–152CrossRefPubMedGoogle Scholar
  8. 8.
    Montupet P, Esposito C (2011) Fifteen years experience in laparoscopic inguinal hernia repair in pediatric patients. Results and considerations on a debated procedure. Surg Endosc 25(2):450–453CrossRefPubMedGoogle Scholar
  9. 9.
    Schier F, Montupet P, Esposito C (2002) Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs. J Pediatr Surg 37(3):395–397CrossRefPubMedGoogle Scholar
  10. 10.
    Spurbeck WW, Prasad R, Lobe TE (2005) Two-year experience with minimally invasive herniorrhaphy in children. Surg Endosc 19(4):551–553CrossRefPubMedGoogle Scholar
  11. 11.
    Takehara H, Yakabe S, Kameoka K (2006) Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions. J Pediatr Surg 41(12):1999–2003CrossRefPubMedGoogle Scholar
  12. 12.
    Shalaby RY, Fawy M, Soliman SM, Dorgham A (2006) A new simplified technique for needlescopic inguinal herniorrhaphy in children. J Pediatr Surg 41(4):863–867CrossRefPubMedGoogle Scholar
  13. 13.
    Endo M, Watanabe T, Nakano M, Yoshida F, Ukiyama E (2009) Laparoscopic completely extraperitoneal repair of inguinal hernia in children: a single-institute experience with 1,257 repairs compared with cut-down herniorrhaphy. Surg Endosc 23(8):1706–1712CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Dutta S, Albanese C (2009) Transcutaneous laparoscopic hernia repair in children: a prospective review of 275 hernia repairs with minimum 2-year follow-up. Surg Endosc 23(1):103–107CrossRefPubMedGoogle Scholar
  15. 15.
    Parelkar SV, Oak S, Gupta R, Sanghvi B, Shimoga PH, Kaltari D, Prakash A, Shekhar R, Gupta A, Bachani M (2010) Laparoscopic inguinal hernia repair in the pediatric age group–experience with 437 children. J Pediatr Surg 45(4):789–792CrossRefPubMedGoogle Scholar
  16. 16.
    Yoshizawa J, Ashizuka S, Kuwashima N, Kurobe M, Tanaka K, Ohashi S, Hiramatsu T, Baba Y, Kanamori D, Kaji S, Ohki T (2013) Laparoscopic percutaneous extraperitoneal closure for inguinal hernia: learning curve for attending surgeons and residents. Pediatr Surg Int 29(12):1281–1285CrossRefPubMedGoogle Scholar
  17. 17.
    Patkowski D, Czernik J, Chrzan R, Jaworski W, Apoznański W (2006) Percutaneous internal ring suturing: a simple minimally invasive technique for inguinal hernia repair in children. J Laparoendosc Adv Surg Tech A 16(5):513–517CrossRefPubMedGoogle Scholar
  18. 18.
    Tatekawa Y (2012) Laparoscopic extracorporeal ligation of hernia defects using an epidural needle and preperitoneal hydrodissection. J Endourol 26(5):474–477CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Grosfeld JL, Minnick K, Shedd F, West KW, Rescorla FJ, Vane DW (1991) Inguinal hernia in children: factors affecting recurrence in 62 cases. J Pediatr Surg 26(3):283–287CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Lauren McClain
    • 1
  • Christian Streck
    • 1
  • Aaron Lesher
    • 1
  • Robert Cina
    • 1
  • Andre Hebra
    • 1
  1. 1.Division of Pediatric SurgeryMedical University of South CarolinaCharlestonUSA

Personalised recommendations