Pediatric Inguinal Hernia Research Articles

Pediatrik İnguinal Herni Onarımı Sonrası Postoperatif Analjezi: Transvers Abdominis Plan Bloğu veya Caudal Epidural Blok

PURPOSE: Transversus abdominis plane (TAP) block under ultrasonography and caudal epidural block are techniques used to provide postoperative analgesia in children. The aim of this study was to compare the effect of these two analgesic techniques in pediatric inguinal hernia operations. 
 MATERIAL AND METHOD: The study included 64 patients aged 4-12 years who underwent surgery for unilateral inguinal hernia. Caudal epidural block was applied to 33 patients (Group C) and TAP block to 31 (Group T). Routine follow-up of postoperative pain for pediatric patients was made with the Wong-Baker faces pain rating scale. A record was made for each patient of the time of requirement for additional analgesia, complications during the intervention and side-effects. 
 RESULTS: In the evaluation of the faces pain rating scale, the scores of Group C were found to be significantly lower than those of Group T at 6, 8, and 12 hours postoperatively (p=0.04, p=0.03, p=0.03). The duration of postoperative analgesia was found to be mean 220 mins (min-max; 118.65 – 355.3 mins) for Group T, and 351.2 mins (min-max; 167.8-617.65 mins) for Group C. The time of first requirement for additional analgesia was mean 13±4.8 hours in Group C, and 8±3.5 hours in Group T (p=0.02). 
 CONCLUSION: The application of caudal block provided more effective postoperative analgesia than TAP block applied under ultrasonography guidance in pediatric inguinal hernia repair.

Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children

BackgroundThis study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair.MethodA retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups.Results155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days–14 years) in the laparoscopic group, 6 months (17 days–13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption.ConclusionsLaparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.

Female pediatric inguinal hernia: uterine deviation toward the hernia side.

We aimed to clarify the frequency and the clinical significance of deviation of the uterus in female pediatric inguinal hernia. We retrospectively evaluated the data of 94 female pediatric inguinal hernia cases that were treated by laparoscopic percutaneous extraperitoneal closure. We assessed for correlations between uterine deviation and age, body weight, the size of the hernia orifice, and the presence of contralateral processus vaginalis (PV) patency. Eighty-four of 94 cases were diagnosed with unilateral inguinal hernia. A total of 62 (73.8%) of these had uterine deviation to the hernia side (Group D); 22 (26.2%) had no deviation to the hernia side (Group N) (P < 0.001). Group D cases were significantly younger than those in Group N (P = 0.0351). There was no difference in body weight, size of the hernia orifice, or contralateral PV patency between the two groups. The incidence of uterine deviation toward the hernia side was statistically significant. It is important to recognize that female pediatric inguinal hernia repair carries an increased risk of ovarian and fallopian tube damage, because these appendages are close to the hernia orifice as a result of the uterine deviation.

Laparoscopic versus open inguinal hernia repair in children: A systematic review.

Purpose:Considerable debates exist regarding the preferable technique to repair a paediatric inguinal hernia (PIH). This systematic review aims to compare the efficacy and safety of laparoscopic herniorrhaphy (LH) and open herniorrhaphy (OH) in PIH.Methods:The randomised controlled trials (RCTs) that compared the outcomes of LH and OH in PIH without region and language restrictions searched from the following databases: PubMed, Web of Science Database, Cochrane Library, SciELO Citation Index, Russian Science Citation Index, China National Knowledge Infrastructure, WanFang Data and China Science and Technology Journal Database.Results:A total of 13 RCTs that involving 1207 patients included in the review. The LH displayed a shorter operative time for bilateral hernia repair (weighted mean difference = −8.23, 95% confidence interval [CI]: −11.22~−5.23, P < 0.00001), a lower complication rate (odds ratio [OR] = 0.32, 95% CI: 013–0.83, P = 0.02) along with a lower wound infection (OR = 0.14, 95% CI: 0.04–0.55, P = 0.005) and major male-specific post-operative complications (OR = 0.10, 95% CI: 0.04–0.24, P < 0.00001) and a less contralateral metachronous inguinal hernia (CMIH) incidence rate (OR = 0.09, 95% CI: 0.02–0.42, P = 0.002). No significant difference was found for unilateral operative time, time to full recovery, length of hospital stay, recurrence and hydrocele rates between the two techniques.Conclusion:The present review reiterates that both the LH and OH techniques for the PIH repair are comparable. However, in some aspects, the LH is superior to the OH in terms of operative time for bilateral hernias, post-operative complications rate and CMIH incidence rate. Rigorously designed RCTs are anticipated to confirm the clinical effects of both LH and OH.

Comparison between caudal epidural and ultrasound-guided ilioinguinal-iliohypogastric block with bupivacaine and dexmedetomidine for postoperative analgesia following pediatric inguinal hernia surgeries: A prospective randomized, double-blind study

Background and Aims:Caudal epidural and ultrasound-guided ilioinguinal, iliohypogastric nerve (IL/IH) blocks are commonly used regional anesthesia techniques for postoperative analgesia in pediatric inguinal surgeries. Dexmedetomidine as an adjuvant has been proven to prolong the duration of both neuraxial and peripheral nerve blocks. We compared the duration of analgesia provided by local anesthetic (LA) and dexmedetomidine for caudal and IL/IH block for pediatric inguinal surgeries.Material and Methods:Forty-six children undergoing inguinal hernia repair were selected for this randomized double-blind study. After general anesthesia, children received either 0.75 mL.kg−1 of 0.25% bupivacaine with 1 mcg.kg−1 of dexmedetomidine in caudal epidural or 0.25 mL.kg−1 of 0.25% bupivacaine with 1 mcg.kg−1 of dexmedetomidine in IL/IH block. The pain was assessed up to 24 h postoperatively using face, legs, activity, cry, consolability (FLACC) score. For FLACC ≥4, rescue analgesia was provided using 1 μg/kg of intravenous fentanyl, up to 2 h postoperatively and 10 mg/kg of oral ibuprofen between 2 and 24 postoperative hours. The time for first rescue analgesia was taken as the duration of analgesia.Results:There were no significant differences in the pain scores or analgesic utilization between the groups. The duration of analgesia of caudal and IL/IH blocks was similar (720.3 ± 430.1 min and 808.4 ± 453.1 min, respectively). The time taken for the performance of block was significantly higher for caudal compared to IL/IH (547 ± 93 vs. 317 ± 179 s; P < 0.001).Conclusion:Both caudal epidural and USG-IL/IH block with dexmedetomidine as additive provide the comparable duration of postoperative analgesia with no significant side effects.

Pediatric Surgeons' Adoption of an Innovative Laparoscopic Technique for Inguinal Hernia Repair: A Mixed Methods Study.

Purpose: We studied adoption of an innovative laparoscopic technique for pediatric inguinal hernia repair by pediatric surgeons and pediatric urologists following dissemination of evidence for its benefits. Methods: This mixed methods study included children who received inguinal hernia repairs during 2017-2019 and their surgeons. We examined surgeons' adoption and use of the innovative technique and rates of ipsilateral recurrence and metachronous contralateral repair. In-depth interviews with surgeons were used to identify themes regarding attitudes and practices regarding the adoption of surgical innovations. Results: No ipsilateral recurrences were noted among open repairs after 1.5 years of average follow-up, while 1.54% (7/453) of unilateral and 0.50% (3/606 sides) of bilateral innovative surgeries required ipsilateral repair after 1.3 years of average follow-up. Among unilateral cases, metachronous contralateral repairs were performed in 1.63% (8/490) of open and 0.44% (2/453) of innovative surgeries. Surgeon interviews identified approaches to continued learning and change; the role of departmental culture, norms, and resources; and technical issues specific to pediatric surgery and pediatric inguinal hernia repair. Conclusions: Outcomes may have improved over time as a consequence of learning. Differences among surgeons and departments influenced the speed of adoption. Surgeons linked the collegial model used when adopting the new technique to the apprenticeship model used during their training. We propose research into the collegial model to improve translation of evidence-based surgical innovations into practice. Level of Evidence: Level III.

The history of the pediatric inguinal hernia repair

The history of inguinal hernia repair is a rich one. For centuries, hernia healers, doctors, anatomists, surgeons and quacks have been devoted to this pathology that has afflicted mankind throughout its evolution. The development of surgical correction mainly focused on adult pathology, with treatments that often involved the loss of the testis. Hernia management in children, however, also dates from antiquity. Described as a swelling on the surface of the belly in ancient papyri, it was treated with tight bandages by the early physicians of Alexandria. For centuries, conservative treatment had been used for the child using primordial trussess, many prayers, and often pagan rituals as the arboreal passage of children described by Marcello of Bordeaux, doctor of the Emperor Theodosius I (347-395 AD), reserving medical intervention only for cases of strangulation in which only reduction was attempted. The middle ages were characterized by an increase in cultural and scientific exchange, during which the first comprehensive surgical textbooks and atlases were written. Different approaches to the inguinal hernia were not taught and passed down through generations of surgeons. The modern era brought a better understanding of the inguinal anatomy, which led to surgical techniques associated with less post-operative complications. Today, the pediatric inguinal hernia repair is one of the most common pediatric operations performed. It is considered a safe procedure with very low complication rate.

Laparoscopic and needlescopic hernia repair for pediatric inguinal hernia: A systematic review with meta-analysis

Background: congenital inguinal hernia is considered to be among the commonest paediatric surgical procedures in daily practice. Open herniotomy with high ligation is of the hernial sac is the gold standard treatment against which all modalities of laparoscopic repair should be compared. With the advances of minimally invasive laparoscopic techniques, less complications and better cosmesis has become the point of study. Objective: was to review the current literature about laparoscopic and needlescopic techniques and highlighting its surgical outcomes. Data source: English midline search using the keywords inguinal hernia, paediatric age, laparoscopy, minimally invasive surgery, needlescopic repair in PubMed, Google scholar, research gate and science direct during the period 1997- 2020. Study selection: article of high quality, randomised controlled trial are only included Data extraction: data were collected, organised according the type of study and extracted systematicallyfrom these studies Data analysis: performed with the IBM SPSS 20.0 software. Conclusion: Laparoscopy has become a good substitution for the open method in the last years due to its advantages and by time minimally invasive manoeuvres became a good substitution for the conventional type of laparoscopic repair as they are easier for the laparoscopic beginners, carry less learning curve, almost have the same results, recurrence rate and have better cosmoses.

Laparoscopic percutaneous extraperitoneal closure with peritoneum reinforcement repair for pediatric inguinal hernia: a single-center experience with over 2,000 patients.

BackgroundInguinal hernia is one of the common diseases in infants and children that requires operative treatment. Laparoscopic inguinal hernia repair in children has become an alternative to the open procedure. Laparoscopic percutaneous extraperitoneal closure with peritoneum reinforcement (LPECPR) is a safe and effective approach for pediatric inguinal hernia, and has a lower recurrence. This is a retrospective study to present our experience with children who underwent LPECPR.MethodsA total of 2,018 patients with inguinal hernia who underwent LPECPR in our hospital from July, 2011 to December, 2020 were reviewed. The surgical technique is modified on the basis of laparoscopic percutaneous extraperitoneal closure (LPEC) to close extraperitoneally by circuit suturing twice around the internal inguinal ring.ResultsAll cases were completed LPECPR without conversion. There were no intraoperative complications. A total of 2,018 patients’ laparoscopic procedures were achieved. The mean operative time was 14 and 20 min for unilateral and bilateral operations, respectively. Follow-up to date is 13.4 months (6–36 months), there were no postoperative complications, such as knot reactions, hydrocele formation, testicular atrophy or pain, except 3 recurrences (3/2,018, 0.15%).ConclusionsThis modified LPECPR technique can acquire lower recurrence rate for repair pediatric inguinal hernia. The midterm safety and efficacy of LPECPR are proven and it can be a routine procedure.

Learning Curve for Laparoscopic Repair of Pediatric Inguinal Hernia Using Percutaneous Internal Ring Suturing.

Background: Percutaneous internal ring suturing (PIRS) is a simple and popular technique for the treatment of inguinal hernia in children. The aim of this study was to analyze the learning curves during implementation of PIRS in our department. Methods: A total of 318 pediatric patients underwent hernia repair using the PIRS technique by three pediatric surgeons with different levels of experience in laparoscopic surgery. These patients were enrolled in a prospective cohort study during the period October 2015–January 2021. Surgical times, intraoperative and postoperative complications, in addition to outcomes of treatment were compared among the pediatric surgeons. Results: Regarding operative time a significant difference among the surgeons was found. Operative time significantly decreased after 25–30 procedures per surgeon. The surgeon with advanced experience in laparoscopic surgery had significantly less operative times for both unilateral (12 (interquartile range, IQR 10.5, 16.5) min vs. 21 (IQR 16.5, 28) min and 25 (IQR 21.5, 30) min; p = 0.002) and bilateral (19 (IQR 14, 21) min vs. 28 (IQR 25, 33) min and 31 (IQR 24, 36) min; p = 0.0001) hernia repair, compared to the other two surgeons. Perioperative complications, conversion, and ipsilateral recurrence rates were higher at the beginning, reaching the benchmarks when each surgeon performed at least 30 PIRS procedures. The most experienced surgeon had the lowest number of complications (1.4%) and needed a fewer number of cases to reach the plateau. The other two surgeons with less experience in laparoscopic surgery had higher rates of complications (4.4% and 5.4%) and needed a higher number of cases to reach the plateau (p = 0.190). Conclusions: A PIRS learning curve for perioperative and postoperative complications, recurrences, and conversion rates reached the plateau after each surgeon had performed at least 30 cases. After that number of cases PIRS is a safe and effective approach for pediatric hernia repair. A surgeon with an advanced level of experience in pediatric laparoscopic surgery adopted the technique more easily and had a significantly faster learning curve.

Pediatric Herniotomy: A 2-year Follow-up Study at Nepal Medical College and Teaching Hospital

Repair of inguinal hernia is one of the most commonly performed pediatric surgical procedures. The standard of treatment has been open herniotomy (OH). Recent trends have shown promising results with use of laparoscopy (LH) for the same. The aim of this study was to compare laparoscopic herniotomy with the standard of care at the time of the study, which has become an increasingly common procedure at our center. This was a prospective follow-up study conducted at the Department of Surgery at Nepal Medical College and Teaching Hospital. A total of sixty-four patients who underwent herniotomy were included in the study and followed up for a total duration of two years post-operatively. Immediate post-op pain was assessed with the use of visual analogue scales. Complications, recurrence, and metachronous herniation were noted in the follow up visits. Use of laparoscopy resulted in a longer operative time (36.68 min vs 22.5 min for OH, P &lt;0.001). Pain scores were similar at immediate post-op period (LH 4.18 vs OH 3.93) but decreased significantly for LH compared to OH at 6 hours (3.68 vs 4.31, P = 0.018), 12 hours (2.71 vs 3.62, P &lt;0.001), and 24 hours (2 vs 3.03, P &lt;0.001). Difference in the mean hospital stay was statistically significant (LH 2.02 days vs OH 2.34 days, P &lt;0.001). No recurrences occurred during the follow up period of the study. No patients developed contralateral metachronous hernia during the follow-up period. The cost of OH compared to LH was significantly less. LH is a safer and better alternative to OH for management of pediatric inguinal hernia when comparing post-op pain and hospital stay. However, duration of surgery and cost for the procedure favor OH at present in our setup.

Double ligation is useful to prevent recurrence for paediatric inguinal hernia in the laparoscopic percutaneous extraperitoneal closure procedure

AbstractAimAlthough laparoscopic percutaneous extraperitoneal closure (LPEC) is the standard procedure for paediatric inguinal hernia repair in our country, recurrence is an important problem. In this study, we examined the usefulness of double ligation in preventing recurrence in the LPEC procedure.MethodsWe retrospectively examined children with inguinal hernias who underwent the LPEC procedure. Cases from October 2012 to June 2016 who underwent surgery for inguinal hernias with single ligation were defined as Group A. Children operated on from July 2016 to April 2019, when double ligation was the standard procedure in our institution, were defined as Group B. We reviewed the operative time and postoperative complications including recurrence rate. Double ligation was performed by holding two threads on the LPEC needle and then binding them individually.ResultsGroup A consisted of 401 patients and Group B consisted of 360 patients. No significant differences were noted between the groups with respect to operative time, infection, metachronous contralateral hernia or testicular atrophy. The recurrence rate was significantly higher in Group A with recurrence occurring in seven cases compared to none in Group B.ConclusionsDouble ligation in the LPEC procedure is useful for preventing recurrence.

Laparoscopic totally extraperitoneal ligation for pediatric inguinal hernia: a novel surgical treatment.

Laparoscopic repair is widely performed for the management of pediatric inguinal hernia (PIH), and different laparoscopic surgical methods are used. Herein, we present the application of laparoscopic totally extraperitoneal ligation (TEPL), which is a novel surgical method for PIH repair and is similar to traditional high ligation. In this study, 103 pediatric patients underwent laparoscopic TEPL for inguinal hernia. Data including demographic characteristics, clinical presentation, time of surgery, length of hospital stay, and postoperative complications were analyzed retrospectively. The patient's median age at surgery was 4.3years, and the median body weight at surgery was 18kg. The preoperative diagnoses were as follows: n = 53, right inguinal hernia; n = 45, left inguinal hernia; and n = 5, bilateral inguinal hernia. All patients were discharged on the day of surgery. The operative times were 27.2min for unilateral inguinal hernia and 28.8min for bilateral inguinal hernia. All patients, except one who had scrotal bruise, did not present with postoperative complications. Laparoscopic TEPL, which is similar to traditional high ligation, is used for the treatment of PIH. Moreover, it is safe, beneficial, and feasible. Double ligation is performed on the extraperitoneal space, and the assessment of contralateral patent processus vaginalis is not complex. However, further studies should be conducted to assess for long-term outcomes.

Comparison of surgical outcomes between laparoscopic percutaneous extracorporeal closure (LPEC) and open repair for pediatric inguinal hernia by propensity score methods and log-rank test analysis.

Despite a number of studies comparing laparoscopic inguinal hernia repair (LH) and open herniorrhaphy (OH), the putative advantage of LH remains controversial due to a paucity of firm evidence. We hypothesized that LH has both advantages and disadvantages compared to OH and sought to clarify them by comprehensively analyzing the retrospective data using the combination of multiple statistical methods. Operative data for inguinal hernia during the period from February 1999 to December 2019 were examined. The patients were assigned into two groups according to the surgical procedure: laparoscopic percutaneous extraperitoneal closure (LPEC, n = 2410) and OH (n = 2038). Operative and anesthesia times and incidence of postoperative complications were evaluated using the propensity score methods and log-rank test. In comparison with OH, operative time of LPEC was longer for unilateral repair (21.59 ± 8.1 min vs 18.01 ± 8.0 min; p < 0.001) and shorter for bilateral repairs (28.55 ± 10.1 min vs 33.23 ± 11.7 min; p < 0.001), while anesthesia times were longer for both unilateral repair (57.67 ± 10.1 min vs 40.62 ± 11.9 min; p < 0.001) and bilateral repairs (65.95 ± 12.5 min vs 56.35 ± 15.1 min; p < 0.001). LPEC significantly reduced the risk of metachronous contralateral hernia (MCLH) (0.52% vs 9.29%; p < 0.001), but the recurrence rate was higher (0.21% vs 0.04%; p = 0.002) than OH. Orchiectomy due to testicular atrophy or torsion was required in 3 cases of OH (0.19%), whereas it was not seen in LPEC. LPEC had a less riskof MCLH and testicular complications but was associated with a higher recurrence rate and longer anesthesia time. Propensity scoring techniques can enhance the robustness of retrospective comparisons between groups over several years of data collection, which is frequently required in pediatric surgery studies.

Surgical Management of Pediatric Inguinal Hernia: A Systematic Review and Guideline from the European Pediatric Surgeons' Association Evidence and Guideline Committee.

Inguinal hernia repair represents the most common operation in childhood; however, consensus about the optimal management is lacking. Hence, recommendations for clinical practice are needed. This study assesses the available evidence and compiles recommendations on pediatric inguinal hernia. The European Pediatric Surgeons' Association Evidence and Guideline Committee addressed six questions on pediatric inguinal hernia repair with the following topics: (1) open versus laparoscopic repair, (2) extraperitoneal versus transperitoneal repair, (3) contralateral exploration, (4) surgical timing, (5) anesthesia technique in preterm infants, and (6) operation urgency in girls with irreducible ovarian hernia. Systematic literature searches were performed using PubMed, MEDLINE, Embase (Ovid), and The Cochrane Library. Reviews and meta-analyses were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Seventy-two out of 5,173 articles were included, 27 in the meta-analyses. Laparoscopic repair shortens bilateral operation time compared with open repair. In preterm infants, hernia repair after neonatal intensive care unit (NICU)/hospital discharge is associated with less respiratory difficulties and recurrences, regional anesthesia is associated with a decrease of postoperative apnea and pain. The review regarding operation urgency for irreducible ovarian hernia gained insufficient evidence of low quality. Laparoscopic repair may be beneficial for children with bilateral hernia and preterm infants may benefit using regional anesthesia and postponing surgery. However, no definite superiority was found and available evidence was of moderate-to-low quality. Evidence for other topics was less conclusive. For the optimal management of inguinal hernia repair, a tailored approach is recommended taking into account the local facilities, resources, and expertise of the medical team involved.

Laparoscopy is increasingly used for pediatric inguinal hernia repair

IntroductionInguinal hernia repairs (IHR) are commonly performed by pediatric surgeons in the United States. The operative approach depends on surgeon preference with no definitive prospective studies comparing laparoscopic inguinal hernia repair (LIHR) versus traditional inguinal hernia repair (TIHR). We aim to assess current practice, hypothesizing that laparoscopy is increasingly used for pediatric IHR. Material & MethodsThe Children's Hospital Association (CHA) Pediatric Health Information System was queried for IHRs performed between 01/01/2009 and 12/31/2018. Demographics, procedure type, hernia laterality, and cost were obtained. Patients were grouped by procedure type (laparoscopic/traditional). Results125,249 IHRs were performed at 32 CHA hospitals during the ten-year study period. 115,782 (92.4%) were TIHR and 9467 (7.6%) LIHR. Use of laparoscopy increased 5-fold from 3% to 15% over the study period. When comparing laparoscopic to traditional IHR groups, there were more females (28.3% vs 12.6%), African-Americans (19.7% vs 14.4%), government-insured (50% vs 45.2%), younger patients (4.2 vs 4.4 years), bilateral IHRs (11.4% vs 7.9%), and higher adjusted total hospital cost ($3,791 vs $2995) in the laparoscopic group (p<0.0001, all comparisons). ConclusionsLaparoscopy for pediatric IHR is increasing at CHA hospitals where nearly 1 in 6 children currently undergoes a laparoscopic repair. The long-term outcomes with laparoscopic repair are worthy of future study.

A Comparative Study of Pediatric Inguinal Hernia Repair by Open Technique versus Laparoscopic Repair

Background: Herniotomy / open surgery has been the time honoured treatment for paediatric inguinal hernia. The improvement of paediatric Laparoscopic hernia and increased experience with Laparoscopic technique become an important skill. Laparoscopic repair of inguinal hernias in children is adopted too quickly, cost effective, cosmetically, less invasive, more feasible and less painful. This procedure is that, it could allow contralateral hernia detection and repair in same setting. Aims and objectives: In our study we aimed to compare between the outcome of inguinal hernia repair in two study group open hernia repair and Laparoscopic hernia repair by Z suture or purse string technique and study to the early and late complication. Materials and methods: the current prospective study carried out in Department of General Surgery, SVBP Hospital Meerut which included 40 patients duration of period from September 2018 to September 2019. Among them, 20 patients in group 1 were repaired by Open procedure and another 20 patients in group 2 were repaired by Laparoscopic procedure. Results: The study included 40 patients. The mean time of operation in Laparoscopic repair (41.50 minute) is slightly shorter than that of open repair (47.50 minute) technique. Postoperative pain was much less in LH group then open hernia group. Hospital stay in LH (1.55 days) and in OH (2.20 days). Oral ships were allowed and well tolerated as early in LH (7.3 hrs) and in OH (10.90 hrs), this was statistically significant. Patients financial satisfaction was lower in group 2than in group 1 repair. Conclusion: The data from study confirmed that the results of Laparoscopic technique has advantage of reduced postoperative pain, diagnosis of CPPV with its management in the same sitting, rapid return to everyday activities, better cosmetic results, cost effective, more feasible and less painful.

One-Trocar Trans-Umbilical Laparoscopic Hernia repair with Intraperitoneal knot in Children

Background: Recently laparoscopic repair of pediatric inguinal hernia has been mainly oriented to video-assisted percutaneous ligation of peritoneal sac. Assessment of contralateral defect and a better cosmesis are recognized benefits of this procedure, however there are still some drawbacks often related to the subcutaneous knot. As an alternative to open surgery we propose an original one-access technique with intraperitoneal knot.

Laparoscopic Inguinal Hernia Repair in Children: To Cut or Not to Cut is the Question?

Context:Laparoscopic repair of pediatric inguinal hernia is gaining popularity, however there is no consensus about the technique of operation.Aims:The aim of the study was to compare the results and complications of two techniques of laparoscopic pediatric hernia repair.Settings and Design:This retrospective study was conducted at the Department of Pediatric Surgery in All India Institute of Medical Sciences (AIIMS), Jodhpur.Subjects and Methods:All children who underwent laparoscopic inguinal hernia repair at AIIMS, Jodhpur, during the period of September 2016–March 2019 were retrospectively studied. Parameters studied included age, gender, side of hernia, technique used, operating time, complications, and hospital stay. Patients were divided into two groups depending on whether the hernial sac was divided or not divided before taking a purse-string suture.Statistical Analysis Used:Student's t-test and Fischer exact test were used to analyze data.Results:A total of 114 patients were included in the study. The median age was 36.4 months. Hernial sac was divided before suturing in 53 patients, while sac was left intact in 61 patients. The mean follow-up was 11.4 months (range: 4–16). Age, gender, side of hernia, complications, and hospital stay were comparable in both groups. There was a significant difference between the mean operating duration in patients who underwent division of hernia sac compared to patients in whom the sac was not divided before putting purse-string suture (92.5 min [45–150] vs. 65.7 [30–90], respectively, P = 0.0101). Hernia recurrence (3.8% in Group A vs. 1.6% in Group B) was comparable in the two groups.Conclusions:Laparoscopic pediatric hernia repair done with or without dividing the peritoneal sac gives comparable results, however operative duration is less if sac is not divided.

Paediatric Laparoscopic Inguinal Hernia Repair: A Comparison Among Techniques

Background: Traditionally in herniotomy, indirect hernial sac is dealt by high ligation and removal of the redundant part, to avoid recurrence. However, some authorities are of the opinion that excision of the hernial sac without ligation, is not associated with recurrence of the hernia. Some have even shown adverse events related to hernial sac ligation like increased post-operative pain and discomfort. There is no consensus on how the hernial sac should be managed during laparoscopic herniotomy. Objectives: Present study aimed to determine the feasibility of laparoscopic sac excision without ligation in paediatric age group, by a randomized comparison. Patients and Methods. This interventional study was performed in the department of Paediatric Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, over a period of one year. A total of 189 patients were included in the study as per inclusion and exclusion criteria and randomized in the three groups. Comparisons were made among three procedures of laparoscopic herniotomy, namely; Percutaneous extraperitoneal closure, Intraperitoneal purse-string closure and laparoscopic sac excision without ligation. The main outcome measures were recurrence rate, operative time, hospital stay, postoperative hematoma and hydrocele formation. Results: Recurrence rate, operative time and hospital stay were not amplified in laparoscopic sac excision procedure than others. Postoperative hydrocele formation were significantly less. Conclusion: Laparoscopic sac excision in indirect paediatric inguinal hernia is safe. The procedure is not associated with early recurrence when it is performed in cases with deep ring diameter less than 10mm.