Recurrent factors after laparoscopic high ligation of hernia sac for pediatric indirect inguinal hernia

Abstract

Objective To explore the recurrent factors after laparoscopic high ligation of hernia sac for pediatric indirect inguinal hernia (IIH). Methods The clinical data were retrospectively analyzed for 264 IIH children undergoing single ligating inguinal ring from January 2008 to December 2014. The relevant factors were age, gender, body mass index (BMI), location of sac, course of disease, incarceration or not, size of internal inguinal ring and suturing type. Multi and uni-variate analyses of recurrent factors were performed with a Logistic regression model. Risk factors of recurrence and risk stratification were analyzed by receiver operator characteristic (ROC) curve. Results A total of 346 operations were performed. There were 229 boys and 35 girls with an average age of (3.3±2.9) (0.25-13) years. The involved sides were right (n=114, 43.2%), left (n=68, 25.7%) and bilateral (n=82, 31.1%). And 11/346 (3.2%) hernias recurred between 1 and 24 months post-operation. Among 11 patients, the youngest age was 4 years. No recurrence was reported for patients aged under 4 years. Uni and multi-variate analyses revealed that age, size of internal inguinal ring and suturing type were associated with recurrent rate. Significant difference existed in the incidence of recurrence among patients with different risk stratifications (χ2=31.434, P<0.05). Conclusions Use of non-absorbable suture is recommended for laparoscopic ligation of pediatric inguinal hernia. And modified laparoscopic high ligation of hernia sac is ideal for children with a high risk of recurrence. Key words: Indirect hernia; Laparoscopy; Relapse