Dan Arbell1, Boris Orkin, Raphael Udassin. 1. Department of Pediatric Surgery, Hadassah-Hebrew University Hospital, Jerusalem, Israel. arbell@hadassah.org.il
Abstract
BACKGROUND: The approach for treating contralateral pediatric inguinal hernias is still controversial. The options are delaying surgery on the contralateral side, automatic exploration, diagnostic laparoscopy through the ipsilateral hernia sac or laparoscopic repair. In children younger than 6 months, occult bilateral hernia is more prevalent, and the hernia sac is difficult for laparoscopic manipulation. We present our early experience with transabdominal laparoscopic hernia repair in infants younger than 6 months of age. METHODS: Thirty four infants younger than 6 months and presenting with unilateral inguinal hernia were operated laparoscopically through a transabdominal approach. Patients were followed for a median of 11 months. RESULTS: Thirty three of the operations were completed laparoscopically. There was a 38.2% incidence of occult bilateral hernia. There were 3 recurrences due to a technical mistake (6.4%), one minor operative complication (needle lost and retrieved) and one minor anesthetic complication (prolonged intubation). In one operation a mini laparotomy was performed to retrieve a needle that was disengaged whilst removed from the abdomen. CONCLUSIONS: Laparoscopic hernia repair is feasible in young infants. It may be particularly suitable for children younger than 6 months. Further studies are needed to assess long-term results.
BACKGROUND: The approach for treating contralateral pediatric inguinal hernias is still controversial. The options are delaying surgery on the contralateral side, automatic exploration, diagnostic laparoscopy through the ipsilateral hernia sac or laparoscopic repair. In children younger than 6 months, occult bilateral hernia is more prevalent, and the hernia sac is difficult for laparoscopic manipulation. We present our early experience with transabdominal laparoscopic hernia repair in infants younger than 6 months of age. METHODS: Thirty four infants younger than 6 months and presenting with unilateral inguinal hernia were operated laparoscopically through a transabdominal approach. Patients were followed for a median of 11 months. RESULTS: Thirty three of the operations were completed laparoscopically. There was a 38.2% incidence of occult bilateral hernia. There were 3 recurrences due to a technical mistake (6.4%), one minor operative complication (needle lost and retrieved) and one minor anesthetic complication (prolonged intubation). In one operation a mini laparotomy was performed to retrieve a needle that was disengaged whilst removed from the abdomen. CONCLUSIONS: Laparoscopic hernia repair is feasible in young infants. It may be particularly suitable for children younger than 6 months. Further studies are needed to assess long-term results.
Authors: Anindya Niyogi; Arpan S Tahim; William J Sherwood; Diane De Caluwe; Nicholas P Madden; Robin M Abel; Munther J Haddad; Simon A Clarke Journal: Pediatr Surg Int Date: 2010-02-09 Impact factor: 1.827