Abstract
BackgroundCongenital defects, such as open processus vaginalis and the canal of Nuck, are common causes of primary pediatric inguinal hernia (PIH). However, in some patients, PIH occurs via acquired defects rather than congenital defects. The most representative cause of PIH is recurrent hernia. Recurrent PIH is treated with high ligation (HL), which is the same method that is used to treat primary PIH. However, the re-recurrence rate of recurrent PIH is high. This study aimed to compare laparoscopic iliopubic tract repair (IPTR) with laparoscopic HL for the treatment of recurrent PIH after primary PIH repair.MethodsFrom June 2013 to March 2019, 126 patients (< 10 years old) with recurrent PIH were retrospectively enrolled. Patients were divided into two groups according to the operative technique: laparoscopic HL (58 patients) and laparoscopic IPTR (68 patients). With HL, the hernial sac was removed and the peritoneum closed. With IPTR, iliopubic tract and transversalis fascia sutures were applied.ResultsThere were no cases of conversion to open surgery. Re-recurrence only occurred in the HL group; no patients in the IPTR group developed re-recurrence (8.6% [5/58] vs. 0.0% [0/68], respectively; p = 0.044). The mean duration from re-operation to re-recurrence in these five patients was 10.6 months. Other surgical outcomes and complications did not differ between the two groups.ConclusionsLaparoscopic IPTR is an effective surgical treatment for reducing re-recurrence of recurrent PIH.
Highlights
Congenital defects, such as open processus vaginalis and the canal of Nuck, are common causes of primary pediatric inguinal hernia (PIH)
For treatment of adult recurrent inguinal hernia, large mesh implantation is recommended to reduce re-recurrence, which is distinct from primary inguinal hernia treatment [10], while prosthetic mesh should never be considered for recurrent PIH repair [1]
Re-recurrence only occurred in the high ligation (HL) group; no patients in the iliopubic tract repair (IPTR) group developed re-recurrence (8.8% [5/57] vs. 0.0% [0/63], respectively)
Summary
Congenital defects, such as open processus vaginalis and the canal of Nuck, are common causes of primary pediatric inguinal hernia (PIH). In some patients, PIH occurs via acquired defects rather than congenital defects. Recurrent PIH is treated with high ligation (HL), which is the same method that is used to treat primary PIH. This study aimed to compare laparoscopic iliopubic tract repair (IPTR) with laparoscopic HL for the treatment of recurrent PIH after primary PIH repair. Methods From June 2013 to March 2019, 126 patients (< 10 years old) with recurrent PIH were retrospectively enrolled. Re-recurrence only occurred in the HL group; no patients in the IPTR group developed re-recurrence (8.6% [5/58] vs 0.0% [0/68], respectively; p = 0.044). Conclusions Laparoscopic IPTR is an effective surgical treatment for reducing re-recurrence of recurrent PIH
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