Reasons for Recurrence After the Laparoscopic Repair of Indirect Inguinal Hernia in Children.

Abstract

To summarize experiences and discuss the reasons for postlaparoscopic indirect inguinal hernia recurrence in children. From June 2008 to June 2013, 6120 laparoscopic inguinal hernia repairs were performed in our hospital involving 5382 males and 738 females. The average age was 3.1 years. When pneumoperitoneum was established, the laparoscopic lens and a clamp were placed into the upper and lower edges of the umbilicus, respectively. Then on the surface projection of the unclosed internal ring, a sled-like needle with suture was circled and tightened on the internal ring at the extraperitoneum. Patients were followed up for between 6 months to 5 years. A total of 21 cases developed recurrent hernia (0.3%). Three main surgical causes of recurrence were concluded: (1) the internal inguinal ring was weak and significantly expanded, especially underneath the internal ring, which led to the peritoneum nearby the internal ring sliding through; (2) a sled-like needle repeatedly perforated the peritoneum, or some of the peritoneum left was unsutured, usually causing a hydrocele; and (3) there was an unexpected release of the ligature around the hernial ring. The majority of recurrent hernias could be cured laparoscopically (n=18), but a small number needed an open repair (n=3). Recurrent hernia still appeared postlaparoscopic inguinal hernia in a small number of patients. The main preventive measures were removal of risk factors for hernia and an appropriate surgical approach.