Laparoscopic Hernia Repair in Neonates, Infants and Children

Abstract

Inguinal hernia is a very common condition in children 1-3 and adults and is the most common operation performed on children 4 (other than ritual circumcision). Since the “classic” open repair was introduced, it has become the standard operation for hernias, with very few controversies: whether the surgeon should perform only a herniotomy or reinforce the repair, whether a contralateral groin exploration be performed, and so forth. The operation is quick, safe, 5 and can be done in an outpatient setting with anesthesia via a laryngeal mask. The recurrence rate is acceptable, 1%-5%6-8, depending on the expertise of the surgeon, the child’s’ age and concomitant diseases. The advent of laparoscopy has changed many dogmas in all fields of surgery, pediatric hernia repair included. Many operations that were considered as “gold standard” are being challenged by the laparoscopic approach and the new technologies it has brought with it. In the specific case of pediatric hernia repair, another challenge on the open technique was introduced by the development of fertility clinics and the higher than expected incidence of azoospermia due to an injury to the vas deferens during bilateral hernia repairs 9-10,14. Therefore, two major applications of laparoscopy were introduced to hernia repair in children. The first, performing an intra-operative diagnostic laparoscopy for diagnosing a non-symptomatic contralateral hernia during open hernia surgery. The second, performing a laparoscopic repair. During the forthcoming chapter, the merits, disadvantages and techniques of both procedures will be reviewed.