Feasibility, advantages, and the outcome of laparoscopic ring closure for repair of inguinal hernia in children: a preliminary experience

Abstract

Background Laparoscopic hernial repair is increasingly adopted even for neonates and has achieved a high success rate with low recurrence rate with long-term follow-up. The main advantages of laparoscopy are no incision of the fascia, exploriation of the other side in case of bilateral hernia, and visualization and safeguarding of the vas deferens and the spermatic vessels. Moreover, it is advantageous over open technique in case of recurrent hernia. Different modalities of techniques have been used for repair such as needlescopic disconnection of hernia sac, flip flap technique, muscular arch repair, and ring closure. Aim The aim of this study was to evaluate the feasibility, advantages, and the outcome of laparoscopic ring closure for repair of the inguinal hernia in children as a preliminary experience in our institution. Patients and methods This prospective study included 30 patients with unilateral and bilateral congenital inguinal hernia who were subjected to laparoscopic repair in the age group of 6 weeks up to 4 years. We use ring closure technique. Results Thirty children met our inclusion criteria; among them, 26 were boys, in whom indirect inguinal hernia sacs were closed (18 right, five left, three bilateral), and in the four girls, all indirect inguinal hernia sacs were closed. Currently, the median operating time for a unilateral hernia is 23 min (range: 19–40 min) and for bilateral hernias is 28 min (range: 25–55 min). There were no complications. Postoperative hydroceles occurred in three boys. Recurrence encountered in two (6.7%) cases. Conclusion The current series shows the feasibility of laparoscopic hernia repair in pediatric patients. Further technical refinement is needed to facilitate its applicability. Even if not used routinely, laparoscopy is a valuable tool for the objective evaluation and management of congenital inguinal hernia in children with advantage of being exploratory and curative with low recurrence and complications rate.