Application of laparoscopy to recurrent inguinal hernia in children

Abstract

Objective To explore the value of laparoscopy in the diagnosis and treatment of recurrent inguinal hernia in children. Methods The clinical data of 67 cases receiving laparoscopic treatment for recurrent inguinal hernia in children at the Department of General Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology were retrospectively analyzed, including the type of hernia recurrence, operation time, intraoperative and postoperative complications, such as short-term hydrocele formation and testicular atrophy and so on. Results In 67 cases, there were 65 males and 2 females.Open repair surgery and laparoscopic surgery were respectively performed in 48 cases and 19 cases for the first operation and the hernia defects were found after operation.Contralateral patent vaginal process deformities were found in 11 sides in the reoperation.Among 67 cases of recurrent inguinal hernia, incomplete ligation of hernia sac was found in 21 cases, low level ligation of hernia sac in 17 cases, no ligation of hernia sac in 14 cases, omissive direct inguinal hernia in 4 cases, loose ligation of hernia sac in 4 cases, overlarge inner ring in 4 cases, weak abdominal muscles in 2 cases, and increased abdominal pressure (long-term constipation, asthma) in 1 case.All the patients were treated by laparoscopic hernia repair and no serious complications occurred during the operation.The average time of unilateral operation was (15.0±2.2) minutes (13-25 minutes), and bilateral operation was (27.0±4.3) minutes (18-41 minutes). All patients were discharged on the second day.Two patients showed short-term postoperative hydrocele and were cured with conservative treatment.During the follow-up time of (23±2) months (9-39 months), no recurrence or testicular atrophy was found. Conclusions Laparoscopy can confirm the type of recurrent inguinal hernia and contribute to reduce postoperative recurrence.Laparoscopic management of recurrent inguinal hernia in children is safe and feasible, which is expected to replace open hernia repair. Key words: Laparoscopy; Recurrent inguinal hernia; Technical improvement; Child