Inguinal Hernia Repair In Children Research Articles

A comparative study examining laparoscopic and open inguinal hernia repair in children: a retrospective study from a single center in China

BackgroundPediatric inguinal hernia (PIH) is a common disease in children. Laparoscopic hernia repair (LHR) has developed rapidly in recent years, but there are still different opinions compared with traditional open hernia repair (OHR). The purpose of this study was to compare the advantages and disadvantages of LHR and OHR in the treatment of pediatric inguinal hernia.MethodsWe performed a retrospective review of all children (< 14 years) who underwent repair of inguinal hernia in the pediatric surgery center of the Affiliated Hospital of Qingdao University from January 2015 to December 2015. We collected the medical records of all the children and analyzed the clinical characteristics, operation-related information and follow-up.ResultsIn the OHR group, 202 cases underwent unilateral inguinal hernia repair, and 43 cases underwent bilateral inguinal hernia repair. In the LHR group, 168 cases underwent unilateral inguinal hernia repair, and 136 cases underwent bilateral inguinal hernia repair. There was a significant difference in the operation time between the two groups, but there were no significant differences in postoperative hospitalization time and incidence of ipsilateral recurrent hernia between the two groups. The incidence rates of metachronous contralateral hernia (MCH) and surgical site infection in LHR group were significantly lower than those in the OHR group.ConclusionOur study shows that compared with OHR, LHR has the advantages of concealed incision, minimal invasiveness, reduced operation time, detection of contralateral patent processus vaginalis, and reduced incidence of MCH. In conclusion, LHR is safe and effective in the treatment of pediatric indirect inguinal hernia.

High recurrence rate of children's inguinal hernia after percutaneous internal ring suturing: a single-center study.

To evaluate and compare the differences in recurrence rates of post inguinal hernia repair in children using Laparoscopic Intracorporeal Closure of the Processus Vaginalis (LICPV) and Percutaneous Internal Ring Closure (PIRS) operating techniques and compare them to published data. A retrospective data analysis of children who underwent LICPV or PIRS techniques between 2005 and 2018 in the tertiary paediatric surgery department of university hospital was done. We analyzed demographic data, operating time, the influence of surgeon, recurrence rate, and the time until recurrence within an observed period of time post-operatively. A total of 240 patients underwent laparoscopic inguinal hernia repair procedures between 2005 and 2018. Of them 138 (57.5%) were male and 102 (42.5%) were female, with mean age of 6.48 (SD ± 4.7). LICPV method accounted for 170 (70.8%) inguinal hernia repairs, whilst 70 (29.2%) underwent the PIRS procedure. The overall recurrence rate was 8.3%; it was significantly higher in the PIRS group (18.6% versus 4.11%, p < 0.05). Males presented higher recurrence rates over females across both procedures. The mean time taken for any recurrence to happen was shorter in patients who underwent the PIRS method as opposed to LICPV techniques, 3.3 and 6.5months, respectively (p > 0.05). In our hands, a significantly higher recurrence rate exists for children undergoing the PIRS method over LICPV techniques when treating inguinal hernias.

Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases

Background: Inguinal hernia is one of the most common conditions presented for surgical repair in children and laparoscopic approaches are increasingly performed. Previous studies have shown safety and efficacy in the use of supraglottic devices (SGD) as an alternative to tracheal intubation, which fits particularly well with outpatient anesthesia.&#x0D; Methodology: we conduct a retrospective observational study, collecting data from the electronic anesthetic form, from all patients aged 0 to 17 y who underwent ambulatory laparoscopic percutaneous internal ring suturing between February 2015 and August 2019, if I-gelTM was used to airway management.&#x0D; Results: We found 230 patients meeting the inclusion criteria. The mean age was 5.2 y old, mean weight 20.1 kg. All patients were ASA I (n=203) or ASA II (n=27). The mean surgery duration was 38 minutes. We found 4 respiratory adverse events, three bronchospasms, and one laryngospasm, managed in the operating room. Ninety percent of the surgeries were performed without neuromuscular blockade.&#x0D; Conclusion: I-gelTM was a safe, effective, and convenient alternative to airway management to laparoscopic inguinal hernia repair in the ambulatory setting. According to available literature, our practice did not represent an increased risk for the studied respiratory events. SGD obviates the need for neuromuscular blockade.&#x0D; Key words: I-gel; Supraglottic devices; Laparoscopy; Inguinal hernia repair; Pediatrics; Anesthesia, ambulatory&#x0D; Citation: Hipólito C, Vieira V, Antunes V, Alves P, Rodrigues A, Santos MJ. Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases. Anaesth. pain intensive care 2020;24(5):&#x0D; Received: 18 February 2020, Reviewed: 5 August, 6 September 2020, Accepted: 11 September 2020

Complications of inguinal hernia repair in children: A tertiary hospital experience

Background: Repair of inguinal hernia is one of the most frequently performed procedures in pediatric surgery. &#x0D; Objective: The aim of this study was to evaluate the complications we encountered following repair of inguinal hernia in children. &#x0D; Methodology: This was a retrospective study done in children aged 15 years and below who had complications following inguinal hernia repair (both emergency and elective) at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria, between January 2014 and December 2018. &#x0D; Results: A total of 1243 cases of pediatric inguinal hernia repairs were performed during the study period. Out of this, 123 patients developed complications, accounting for 9.9% of the total cases. There was male predominance with a median age of 1 year. Most of the complications were noted in infants undergoing emergency repairs. Scrotal complications were the most common complications which resolved on non-operative treatment. Other complications in descending order of frequency included wound infection, hernia recurrence, testicular atrophy and sensory disturbances in the inguinal region. There was no mortality following the surgeries. &#x0D; Conclusion: Pediatric inguinal hernia repair is a procedure with potential complications more so in infants following an emergency repair. Preoperative parental counseling and timely referral are mandatory.

The Incidence of Recurrence after Laparoscopic Versus Open Inguinal Hernia Repair in Children: a Systematic Review and Meta-Analysis

Inguinal surgery is one of the most common surgical procedures in children. However, whether laparoscopic hernia repair is superior to open hernia repair remains unclear. To undertake a systematic review and meta-analysis of randomized controlled trials evaluating the recurrence rate after laparoscopic hernia repair and open hernia repair in children who underwent repair for pediatric inguinal hernia. The Web of Science Database, Pubmed, Embase, WanFang Data, China National Knowledge Infrastructure, and Cochrane Central Register of Controlled Trials were searched to identify eligible studies. The outcomes evaluated were the recurrence rates including metachronous contralateral inguinal hernia and the complication rates associated with both laparoscopic hernia repair and open hernia repair. Seventeen RCTs including 2122 children (2540 hernia defects) were analyzed. Methodologic quality was unclear in most trials. The recurrence rate after inguinal hernia repair in children was 1.3% (33/2540). Meta-analysis of randomized trials did not reveal significant difference between the 2 techniques in the incidence of recurrence (relative risk [OR] = 0.48, 95% confidence interval [CI] = 0.12–1.82, P = 0.280). Simultaneously, there were no significant differences between laparoscopic hernia repair and open hernia repair in the incidence of metachronous contralateral inguinal hernia (OR = 0.33; 95% CI, 0.05–2.30; P = 0.270) and postoperative complications (OR = 0.58; 95% CI, 0.20–1.71; P = 0.320). Laparoscopic repair of a Pediatric hernia does not offer significant advantage over open hernia repair, therefore a decision to perform laparoscopic and/or open repair is best left to the surgeon, expertise available and parents in respective geographic area.

A Faster and Simpler Operation Method for Laparoscopic Inguinal Hernia Repair in Children.

Background: Inguinal hernias (IHs) are common in infants and children. The key step in inguinal hernia repair is high ligation of the hernia sac. The current main treatment methods for IHs are open and laparoscopic surgery. Over the past two decades, laparoscopic herniorrhaphy has increased in popularity. Herein, we introduced a new method to laparoscopically treat IHs. The goal of this study was to investigate the clinical effects and advantages of this new operation technique for IHs, which is called the "hernia sac ligation by single-incision laparoscopic surgery with a double-line band method." Patients and Methods: We retrospectively reviewed the records of all children who underwent initial laparoscopic herniorrhaphy at our center over a 1-year period. A single surgeon performed all surgeries using the modified single-incision laparoscopic technique. Intraoperative findings and complications, operative times, and postoperative complications were reviewed for all children. Results: All 119 surgeries were successfully completed (58 bilateral and 61 unilateral). In total, 54 out of 58 children had contralateral openings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. This clinical study included 99 boys patients and 20 girls patients (boy-to-girl ratio was 4.95:1). The age range at the time of surgery was 0.5 to 10 years, and the average age was 2.63 years. No patient had any intraoperative complication. Postoperative complications occurred in 1 boy (0.56%) who had a hernia recurrence that required open repair. The addition of auxiliary operating forceps was required for 8 boys (6.72%). No child had scrotum edema, wound infection, stitch granuloma, or iatrogenic cryptorchidism. Overall, a 93.3% operative success rate was noted with the modified technique. Conclusions: The modified technique is a safe and effective operation method, which can significantly shorten the operation time, reduce recurrence rates, and result in minimal scarring. Additionally, the procedure is expected to be less expensive.

Indirect inguinal hernia repair conducted with single conventional port intracorporeal conventional equipment-endoscopic surgery.

Laparoscopic or laparoscopy-assisted inguinal hernia repair (IHR) can be performed using one port plus two stab wounds. We herein present our experience with laparoscopic IHR conducted using a single conventional port and a single working instrument. The records patients who underwent single conventional port intracorporeal IHR during November 2013-December 2018 were evaluated. The main outcome measurements were patient's demographic characteristics, hernia side, presence of incarceration, operative time, and complications. A total of 132 inguinal hernias (52 right, 40 left, and 20 bilateral) were repaired in 112 patients (76 boys, 36 girls). The mean ages of the patients were 69.8 ± 53.4months (3months to 17years). In six patients, contralateral processus vaginalis was found to be patent during operation. Incarcerated inguinal hernia was present in two patients. Mean operative time was 17.9 ± 3.8min (9-30min) in unilateral hernias and 28.9 ± 6.5min (24-45min) in bilateral hernias. No intraoperative and postoperative complications were encountered. The mean hospital stay of the patients was 8.8 ± 5.0h (4-36h). Postoperative follow-up was 16.5 ± 5.1months (6-24months). No recurrent inguinal hernias were detected during follow-up. Single conventional port intracorporeal IHR obviates additional stab wounds. Additionally, present technique eliminates the risk of skin puckering, subcutaneous granuloma, infection, nerve, and muscle damage development induced by the subcutaneously placed knot in laparoscopy-assisted IHR. Single conventional port intracorporeal IHR in children is a feasible and safe operative technique with low complication rates.

Congenital inguinal hernia repair with and without opening the inguinal canal

Abstract Background Elective repair of congenital inguinal hernia is the most common surgery performed by pediatric surgeons and is considered the treatment of choice. The exact technique and steps involved in the repair differs widely among pediatric surgeons, many surgeons open the roof of inguinal canal while preserving the external ring or opening it, this is called the modified Ferguson, s technique. In infants, the inguinal canal is short and virtually the internal and external rings lie over each other so many surgeons also like to perform the whole operation without opening the external oblique aponeurosis distal to the external ring, this technique is called the Mitchell Banks technique. Objective To compare both techniques regarding intraoperative time, incidence of intraoperative and postoperative complications to pass our experience in a trial to reach an ideal surgical technique for congenital inguinal hernia repair. Patients and Methods In this study, 60 cases of congenital inguinal hernia were randomly selected and divided into two equal groups where group A underwent the repair with opening the external oblique aponeurosis and group B underwent the repair without opening the external oblique aponeurosis. Results As regard the postoperative complications, the patients who underwent the Ferguson’s technique experienced more postoperative pain with statistically significant more incidence of postoperative hydrocele than the Mitchell banks technique, no complications occurred postoperatively other than hydrocele in our study. Conclusion Our study results, we can approve that Mitchell Banks technique is easier, consumes less time than Ferguson’s technique with less incidence of postoperative complications and pain which can make this technique better for congenital inguinal hernia repair in children aging 2 years or less.

Single-incision approach for bilateral inguinal hernia repair in children: A retrospective study.

To introduce the use of a new surgical approach named single-incision bilateral inguinal herniorrhaphy (SBIH) in pediatric surgical population.This was a STROBE-compliant retrospective cohort study using data from 101 patients who had undergone bilateral inguinal herniorrhaphy in our institution. Children with bilateral inguinal hernias without contraindications for surgery, ranging in age from 6 months to 12 years, were included. Fifty-six children with bilateral inguinal hernias underwent SBIH (SBIH group) and 45 patients underwent laparoscopic bilateral inguinal herniorrhaphy (LBIH) (LBIH group). Differences in operative time, postoperative pain, recurrence, and complications between the 2 groups were analyzed. Patient satisfaction with cosmetic result was also investigated using questionnaires.There were no statistically significant differences in operative time (P = .2257), postoperative pain (P = .0607), recurrence (P = .8756), and complications (P = .7467) between the 2 groups. Interestingly, the operation time of girls in SBIH group was significantly shorter than that of the boys in this group (P < .0001), but also shorter than that of girls in LBIH group (P = .0038). Postoperative pain for boys was lower in SBIH group than in the LBIH group (P = .0340). No ascending testis, testicular atrophy, and hydrocele occurred in either group. According to the questionnaire, both procedures had equally high levels of satisfaction for cosmetic results (P = .7531).Initial results show that SBIH for pediatric patients, regardless of gender, is a safe and feasible procedure compared with LBIH with an equally low recurrence rate, few complication, and satisfactory cosmetic outcomes.

Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures

Introduction: There have been multiple descriptions for the laparoscopic repair of inguinal hernia in children. Except for one, they all involve a suture ligation of the internal ring. Our concern is that suture ligation of the internal ring can injure the vas deferens, gonadal vessels, or cause unnecessary bleeding. We report the results of our laparoscopic inguinal hernia repairs, where we incise the peritoneum of the internal ring, and dissect the tunica vaginalis for 1 cm. We do not suture ligate the internal ring. This includes patients who underwent laparoscopic evaluation and treatment for intraabdominal testicles, and thus have 6 month laparoscopic follow-up of those patients having a staged orchiopexy. Study design: We reviewed the charts from 2005 to 2016 of all patients with CPT codes 54692 (laparoscopic orchiopexy) and 49650 (laparoscopic inguinal hernia). During laparoscopy for the nonpalpable testicle, we proceeded to either a one stage or 2 stage orchiopexy. When we observed inguinal hernia opening on the contralateral side of the undescended testicle, we repaired it by incising around the internal ring, and carefully excising the tunica vaginalis from the internal ring for a distance of 1 cm, leaving the internal oblique muscle to heal together, and peritoneum to resurface the area, without using sutures. (This is the same as is done for the laparoscopic orchiopexy side). In those patients with a staged orchiopexy, and we reevaluated the hernia sight for closure. Results: We reviewed charts of 87 patients with ages ranging from 3 months to 10 years. Eighteen of these had bilateral laparoscopic orchiopexy, 38 had left, and 24 had right. We performed 21 bilateral laparoscopic hernia repairs, 27 had left only, and 18 had right only. Of those patients with hernias, 11 hernias were found on the side opposite an undescended testis. In 4 patients we had the opportunity to perform a second stage orchiopexy six months later and observed the inguinal ring had closed. Follow up was at least 6 months for all patients, and no clinical hernias resulted. Conclusion: Laparoscopic inguinal hernia repair in children can be successfully and safely performed by excising the hernia sac (patent processus vaginalis) from the inguinal canal, and does not require suture ligation of the internal ring.

Laparoscopic inguinal hernia repair in children: To cut or not to cut that is the question?

To compare the results and complications of two techniques of laparoscopic paediatric hernia repair. All the children who had laparoscopic inguinal hernia repair done at AIIMS Jodhpur during the period of Sept 2016 to Nov 2017 were retrospectively studied. Patients were divided in two groups depending on whether the hernial sac was divided or not divided before taking a purse-string suture. Total 39 patients were included as per inclusion criteria. Mean age of the patient was 35.4 months (range is 2 months to 12 years). We had 7 female patients. Side of the hernia was bilateral in 7 patients, left side =13 and right side=19 making a total of 46 hernias. Hernial sac was divided before suturing in 17 patients while the sac was left intact before suturing in 22 patients. Mean follow up was 6.7 months (range: 1 to 14). Age, gender, side of hernia, complications and hospital stay were comparable. There was a significant difference between the mean operating times in patients who underwent division of hernia sac with patients in whom the sac was not divided before putting purse-string suture (92.5 mts vs 65.7 mts) respectively, p= 0.0101). One patient in the division of sac group had injury to testicular vessel while dividing the sac while one patient developed hydrocele on follow-up in the other group. There was no recurrence in either of the group. Repair done with or without dividing the peritoneal sac gives comparable results with lower operating time without sac division.

Outcomes of laparoscopic incarcerated inguinal hernia repair in children.

Aim:Laparoscopic inguinal hernia repair (LIHR) is gaining widespread acceptance, but its role in the management of incarcerated cases is not well outlined. This review analyses the outcomes of laparoscopic repair of incarcerated inguinal hernia in children.Patients and Methods:Literature was searched on PubMed® using terms 'laparoscopic', 'incarcerated', 'inguinal', 'hernia' and 'children'. Age, sex, side, sac content, operative technique, follow-up period, complication and recurrence rate were analysed.Results:Fifteen articles with 689 paediatric incarcerated inguinal hernias were identified between 1998 and 2018. Median age of patients was 22.4 months (2 weeks–16 years; M:F = 2.2:1). Side was mentioned in n = 576: n = 398 (69.1%) right and n = 178 (30.9%) left. In n = 355 (51.5%) manual reduction and delayed surgery (MRDS), in n = 34 (4.9%) manual reduction in general anaesthesia (MRGA) followed by emergency LHR and in n = 300 (43.5%) intraoperative reduction (IOR) was necessary. Incarcerated contents were documented in n = 68: intestine n = 36 (52.9%), ovary n = 14 (20.6%), omentum n = 11 (16.2%), appendix n = 5 (7.4%) and Meckel's diverticulum n = 2 (2.9%). Among the n = 18 girls in IOR group, n = 14 (77.8%) had ovaries incarcerated. For LHR, the hook method was used in 376 (54.6%) and purse-string suture in 313 (45.4%), with two conversions in IOR group. Mean followup was 15 months (3–80 months), with one (0.15%) testicular atrophy, and 4 (0.58%) recurrences in MRDS and 1 (0.15%) in IOR. All five cases were closed with pursestring technique. Total recurrence rate was 0.73%; significantly higher (P = 0.014) with pursestring (n = 5, 1.6%) than with the hook (none).Conclusion:Hook and purse-string methods are equally popular in LHR for paediatric incarcerated hernias, with 50% hernia reductions possible at the time of surgery. Recurrence rate is low and comparable with non-incarcerated hernias; however, it is significantly higher in purse-string method than hook technique.

The Ideal Candidate for Subcutaneous Endoscopically Assisted Ligation (SEAL) of the Internal Ring for Pediatric Inguinal Hernia Repair

Subcutaneous endoscopically assisted ligation (SEAL) technique is an effective and minimally invasive approach for indirect inguinal hernia repair in children. Not all patients are candidates for SEAL because of technical limitations. We hypothesized that preoperatively assessed patient-level factors may predict technical feasibility of SEAL repair. We performed a retrospective review of all patients who underwent indirect inguinal hernia repair between June 2012 and December 2014. All patients younger than two years and any patient older than two years who had a concomitant umbilical hernia were considered candidates for diagnostic laparoscopy with SEAL repair. We compared patients who had SEAL repair with those who had diagnostic laparoscopy with conversion to open repair. Univariate statistics was performed using the chi-squared and Student's t test. One hundred forty-one patients underwent diagnostic laparoscopy with intent to perform a SEAL repair. Seventeen patients were lost to follow-up. Of the remaining 124 patients, 66 had SEAL repairs, 35 had open repairs, and 23 had a SEAL repair with contralateral open repair. Patient age, BMI, gender, history of prematurity, and history of incarcerated hernia were similar between the SEAL and open groups. Sixty-two per cent of hernias were able to be repaired with SEAL technique. Hernia recurrence was seen in 3 of 123 total SEAL repairs and in 1 of 74 open repairs. The recurrence rate for SEAL repairs (2.4%) was not significantly different from the recurrence rate for open repairs (1.4%). No preoperative patient-level factors predicted technical inability to perform a successful SEAL repair. In this series, the recurrence risk of SEAL compared with open repair was low and not statistically significant. For practitioners with minimally invasive experience, SEAL should be considered a safe and successful option for inguinal hernia repair in pediatric patients undergoing routine diagnostic laparoscopy.

Comparison between rectus sheath block with 0.25% ropivacaine and local anesthetic infiltration with 0.5% ropivacaine for laparoscopic inguinal hernia repair in children.

ABSTRACTThis randomized, observer-blinded prospective study aimed to compare the postoperative analgesic effects of ultrasound-guided rectus sheath block with those of local anesthetic infiltration of the surgical field in children undergoing inguinal hernia repair. Children aged 2 to 14 years, scheduled for elective single-incision laparoscopic percutaneous extraperitoneal closure, were randomly allocated to receive ultrasound-guided rectus sheath block (group R) or local anesthetic infiltration of the surgical field (group L). In group R, 0.5 ml/kg of 0.25% ropivacaine (per side) was administered after intubation. In group L, 0.4 ml/kg of 0.5% ropivacaine was administered after peritoneal closure. Postoperative pain was assessed using the Face Scale and Face, Legs, Activity, Cry, Consolability scale at various time points, including the primary endpoint of 2 h after leaving the operation room. Additional analgesic drugs were used according to the Face Scale scores. Patient characteristics, the amount of additional drugs, and complication rate were evaluated in both groups. The patient and surgical characteristics were comparable between groups. The Face Scale and Face, Legs, Activity, Cry, Consolability scale scores were not significantly different between group R (n = 38) and group L (n = 38) at 2 h after leaving the operation room. The amount of additional drugs administered at 2 h after leaving the operation room were also comparable between groups. Our findings suggest that the postoperative analgesic efficacy of ultrasound-guided rectus sheath block is not superior to that of local anesthetic infiltration of the surgical field for pediatric single-incision laparoscopic percutaneous extraperitoneal closure.

Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis

BackgroundLaparoscopic inguinal hernia repair in children is increasingly performed as it allows contralateral inspection and potentially results in shorter operation time and less complications. Evidence from meta-analyses of randomized controlled trials (RCTs) regarding the superiority of laparoscopic versus open hernia repair is lacking.MethodsA systematic literature search was performed querying PubMed, Embase, MEDLINE, and the Cochrane Library databases. RCTs comparing laparoscopic with open hernia repair in children were considered eligible, without year and language restrictions. Cochrane Risk of Bias tool was used for quality assessment. Data were pooled using a random-effects model. Subgroup analyses were performed according to the laparoscopic suturing technique (i.e., intracorporeal or extracorporeal).ResultsEight RCTs (n = 733 patients; age range 4 months–16 years) were included in this meta-analysis. Laparoscopic (LH) and open (OH) hernia repair was performed in 375 and 358 patients, respectively. Complications (seven RCTs, n = 693; pooled OR 0.50, 95% CI 0.14 to 1.79), recurrences (seven RCTs, n = 693; pooled OR 0.88, 95% CI 0.20 to 3.88), and MCIH rates (four RCTs, n = 343; pooled OR 0.28, 95% CI 0.04 to 1.86) were not different between the groups. LH resulted in shorter bilateral operation time (Five RCTs, n = 194; weighted mean difference (WMD) − 7.19, 95% CI − 10.04 to − 4.34). Unilateral operation time, length of hospital stay, and time to recovery were similar. There was insufficient evidence to assess postoperative pain and wound cosmesis, and evidence of substantial heterogeneity between the included studies. Subgroup analyses demonstrated less complications and shorter unilateral operation time for extracorporeal suturing and shorter length of hospital stay for intracorporeal suturing.Conclusions and relevanceNo definite conclusions to decide on the superiority of one of either treatment strategies can yet be drawn from the available literature. There was evidence of substantial heterogeneity and the clinical relevance of most estimated effects is very limited.

Is the Laparoscopic Approach Safe for Inguinal Hernia Repair in Preterms?

Introduction: Although laparoscopic inguinal hernia repair in children has gained popularity in the last decades, this approach remains uncommon in preterm infants. The aim of this study was to compare the characteristics and the outcomes of indirect inguinal hernias in term and preterm infants. Material and Methods: From January 2002 to November 2015, all charts of the pediatric patients who underwent laparoscopic indirect inguinal hernia repair in one single institution within the first 6 months of life were revised. The data of 156 patients were analyzed retrospectively. Patients were divided in two groups: group I, including the preterm patients, and group II, including the term patients. Results: A total of 90 preterm infants and 66 term infants were included. In the group I, preoperative diagnosis was right-sided inguinal hernia in 20% of patients, left sided in 22.2%, and bilateral in 57.5%; while in the group II, preoperative diagnosis was right-sided inguinal hernia in 42.4% of infants, left sided in 15.2%, and bilateral in 42.4% (P = .01). In group I intraoperative diagnosis was right-sided inguinal hernia in 10% of patients, left sided in 16.7%, and bilateral in 73.3%; while in the group II, intraoperative diagnosis was right-sided inguinal hernia in 25.8% of infants, left sided in 12.1%, bilateral in 60.6%, and there was no hernia in one patient (P = .02). However, there was no statistically significant difference in the correct intraoperative diagnosis between both groups (P = .59). No statistical significance was observed between the two groups regarding postoperative complications. Conclusions: Bilateral inguinal hernia is more frequent in preterm infants compared to term infants, whereas the incidence of right-sided inguinal hernia is higher in term patients. Laparoscopic inguinal hernia repair in preterm infants seems to be safe and effective.

Needlescopic assisted internal ring suturing; a novel application of low-cost home-made instruments for pediatric inguinal hernia repair.

Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants and children. Single port laparoscopic hernia repair using percutaneous internal inguinal ring (IIR) suturing procedure is a widely employed technique for indirect inguinal hernia repair in children. The majority of extracorporeal techniques use extracorporeal knotting and burying the knot subcutaneously. This may result in many drawbacks. The aim of this multicenter study is to introduce a new technique for pediatric inguinal hernia repair using only needles without any laparoscopic instruments. This is a multicenter study which was conducted at Pediatric Surgical Departments of Al-Azhar, Mansoura, Alexandria and Tanta Universities during the period from January 2015 to June 2017. 314 patients with CIH underwent Needlescopic Assisted Internal Ring Suturing (NAIRS) after cauterization of the hernia sac at its neck. The main outcome measures were: feasibility, safety of the technique, operative time, recurrence rate, hydrocele and cosmetic results. A total of 314 patients with CIH were corrected by NAIRS. They were 232 males and 82 females. The mean age was 28.12 ± 1.3months (range 6-120months). The mean operative time was 12.6 ± 1.7min (range 8-15min) for unilateral cases and 18.6 ± 1.7min (range 14-20min) for the bilateral repairs. All cases were completed laparoscopically without major intraoperative complications. No recurrence was detected in this study. No wound complications or umbilical hernias developed. Hydrocele occurred in five males (2.16%), without detection of testicular atrophy or iatrogenic ascent of the testis. This preliminary study showed that NAIRS after cauterization of the neck of the hernia sac in infants and children is safe, feasible, reproducible with excellent cosmetic results.

Toward sutureless laparoscopic inguinal hernia repair in children?

We report our experience with a sutureless technique for laparoscopic inguinal hernia repair in children. Twenty-eight children, 12 girls and 16 boys, aged 3 months to 7 years, underwent sutureless laparoscopic inguinal hernia repair. In girls, we utilized simple cauterization of the internal inguinal ring with a single trocar technique. In boys denudation of the peritoneum was obtained utilizing a three-trocar technique. The peritoneum around the internal inguinal ring was peeled off and detached from the vas and the vessels, and then wrapped around the grasper, resulting in a large area of denudation. No perioperative complications were observed. No recurrences nor testicular damage were noted after a mean follow-up of 18 months (range 6-35 months). The mean operative time was 12 min (range 7-20 min) for girls and 19 min (range 15-30 min) for boys. A 6-year-old girl exhibited a lymphocele. The sutureless technique appears to be easy, safe, and effective, provided that the patients are carefully selected. In boys, special attention needs to be paid to preservation of the vas and the testicular vessels.

Three minutes propofol after sevoflurane anesthesia to prevent emergence agitation following inguinal hernia repair in children: a randomized controlled trial.

BackgroundEmergence agitation (EA) is a common problem after sevoflurane anesthesia among children. There have been mixed results with control of EA using propofol 1 mg/kg bolus following sevoflurane anesthesia. An infusion of 3 mg/kg of propofol over 3 min following sevoflurane anesthesia has been found to be promising in children undergoing magnetic resonance imaging scans. However, no studies have been conducted during surgical procedures. We aimed to examine the efficacy of transition to propofol for 3 min after cessation of sevoflurane anesthesia in children undergoing inguinal hernia repair.MethodsIn this prospective randomized controlled trial, 64 children aged 1–12 years, scheduled for inguinal hernia repair, were randomized to receive either propofol 3 mg/kg over 3 min (propofol group) or no propofol (control group), after the cessation of sevoflurane anesthesia. EA was assessed using the Paediatric Emergence Anesthesia Delirium (PAED) scale and the Watcha scale. Emergence time and the duration of post-anesthesia care unit (PACU) stay were also recorded.ResultsThe incidence of ED was lower in the propofol group on both the PAED (81.3% vs. 15.6%, P < 0.001) and the Watcha (78.1% vs. 15.6%, P < 0.001) scales. The mean emergence time was 6.37 minutes longer in the propofol group with no significant difference in PACU times.ConclusionsTransition to propofol 3 mg/kg over 3 min following sevoflurane anesthesia reduces the incidence of EA and improves the quality of emergence. Although emergence times were longer, the duration of stay in the PACU was similar with propofol use.

Intravenous dexamethasone along with caudal block improves analgesic efficacy following day-case inguinal hernia repair in children: A randomized controlled trial.

To assess the effectiveness of intravenous dexamethasone along with caudal block in improving analgesia following inguinal hernia repair in children. The double-blind randomised controlled trial was conducted over a 6-month period from June 01, 2016 to November 30, 2016 at the Aga Khan University Hospital, Karachi, and comprised patients aged 1-5 years, scheduled for elective inguinal hernia repair. The subjects were randomised into two groups using the sealed envelope technique. Group D patients received 0.5mg/kg dexamethasone intravenous in 5ml, and group P was given placebo (5ml 0.9% saline). Assessment of postoperative pain was made through the faces, legs, activity, cry and consolability tool at 30 minutes and hourly for 4 hours. Rescue analgesia was given at pain score 3 or more with intravenous pethidine 0.5 mg/kg. SPSS 19 was used for data analysis. Of the 64 patients, there were 55(85.9%) boys and 9(14.1%) girls. The overall mean age was 29.8}13.8 months. The mean postoperative pain score was significantly higher in group P (p<0.05). At 30 minutes and two hours postoperatively, need for analgesia was also significantly higher in group P (p<0.05). In paediatric day-care inguinal hernia repair, dexamethasone could be used effectively for improving pain relief.