Two ports laparoscopic inguinal hernia repair in children.

Medhat M Ibrahim

doi:10.1155/2015/821680

Abstract

Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac. Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation to other modalities of repair was the aim of this work. 90 children including 75 males and 15 females underwent surgery. Hernia in 55 cases was right-sided and in 15 left-sided. Two patients had recurrent hernia following open hernia repair. 70 (77.7%) cases were suffering unilateral hernia and 20 (22.2%) patients had bilateral hernia. Out of the 20 cases 5 cases were diagnosed by laparoscope (25%). The patients' median age was 18 months. The mean operative time for unilateral repairs was 15 to 20 minutes and bilateral was 21 to 30 minutes. There was no conversion. The complications were as follows: one case was recurrent right inguinal hernia and the second was stitch sinus. Discussion. The results confirm the safety and efficacy of two ports laparoscopic hernia repair in congenital inguinal hernia in relation to other modalities of treatment.

Highlights

Several laparoscopic treatment techniques were designed for improving the outcome over the last decade
With the increase in laparoscopic inguinal hernia repair, several treatment techniques have developed over the past two decades, aimed at improving the outcome [3]; the various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, endoscopic instruments used, mode of dissection of the hernia sac, and extracorporeal and intracorporeal suturing and knotting techniques [4]
There are still some issues regarding the introduction of laparoscopic inguinal hernia repair as the gold standard method, especially taking into consideration the possible longer operative time and the inevitable need for three separate ports which is the case in routine laparoscopic herniotomy techniques

Summary

Introduction

The trend toward laparoscopic approach for hernia repair in children has been increasingly justified. The ability to detect and repair the contralateral opening of internal rings simultaneously, along with safe high ligation of the hernia sac without injury of the vas deference or the spermatic vessels, make laparoscopic approach a reliable alternative to the conventional open techniques [1]. (1) Most of these methods employ a laparoscope inserted via an umbilical incision and two lateral ports for instruments to ligate the hernia defect [2]. With the increase in laparoscopic inguinal hernia repair, several treatment techniques have developed over the past two decades, aimed at improving the outcome [3]; the various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, endoscopic instruments used, mode of dissection of the hernia sac, and extracorporeal and intracorporeal suturing and knotting techniques [4]. I used two 5 mm ports which reduce the port numbers and size, the purse string suturing, and extracorporeal knotting of the hernia sac

Materials and Surgical Technique

Findings

Discussion