Laparoscopic Inguinal Hernia Repair in Infants and Children: State-of-the-Art Technique

AbstractPediatric inguinal hernia is one of the most common surgical conditions with open herniotomy being the gold standard of treatment. With the advances of laparoscopic surgery, it has emerged as an alternative to open repair with reported good results. However, laparoscopic hernia repair is not yet a routine procedure in many centers, and debate of laparoscopic versus open repair still exists. After 20 years of development of laparoscopic hernia repair, different techniques have been described with no consensus on the standard technique right now. This article reviews the latest updates of laparoscopic repair from the current evidence in the literature. Laparoscopic management of hernia in premature/small infants and hernia incarceration are also discussed here.

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A prospective comparative study of outcome between open lichtenstein versus laparoscopic repair of inguinal hernia

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211879 ◽

2021 ◽

Vol 9 (5) ◽

pp. 1417

Author(s):

Sushila Choudhary ◽

Hitesh Soni ◽

Jagdish M. Mehta ◽

Saurabh Kalia

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Operative Time ◽

Open Repair ◽

Laparoscopic Hernia Repair ◽

Laparoscopic Group ◽

Usual Activity ◽

Time Duration ◽

Post Operative Pain ◽

Hospital Stays

Background: Laparoscopic hernia repair is technically difficult and has long learning curve than open repair. Moreover, with increased cost of procedure do patient really get benefited in terms of intraoperative time duration, post-operative pain and complications, length of hospital stays, and time taken to return to usual activity needs to be studied.Methods: In this prospective observational study of 100 patients including unilateral, bilateral, direct and indirect inguinal hernia and excluding obstructed and strangulated hernia, 61 patients underwent open repair and 39 patients underwent laparoscopic hernia repair. Pain analysis was done with visual analogue scale. Unpaired student T test and Chi square test used (p<0.05).Results: Baseline characteristics age, sex of the two groups were similar. Mean operative time in laparoscopic group was 105.38±35.13 minutes and in open group was 79.95±31.12 minutes (p<0.001). There was statistically significant difference in mean pain score of laproscopic verses open techniques (p<0.001). Urinary retention was the most common post-operative complication in both groups but was statistically not significant. Mean hospital stay in laparoscopic group was 1.56±0.50 days and in open group was 1.9±0.50 days (p-0.002). Mean time taken to return to usual activity in open repair was 41.10±27.15 days and in laparoscopic group was 16.23±6.37 days (p-0.001).Conclusions: This study showed that in laparoscopic repair of inguinal hernia patients have less post-operative pain, shorter hospital stays and early return to work. However, the laparoscopic technique had longer operative time duration.

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

Surgical Endoscopy ◽

10.1007/s00464-019-06960-2 ◽

2019 ◽

Vol 33 (10) ◽

pp. 3177-3191 ◽

Cited By ~ 8

Author(s):

Kelly Dreuning ◽

Sanne Maat ◽

Jos Twisk ◽

Ernest van Heurn ◽

Joep Derikx

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

State Of The Art ◽

Meta Analysis ◽

Future Perspectives ◽

Pediatric Inguinal Hernia

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Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm11020321 ◽

2022 ◽

Vol 11 (2) ◽

pp. 321

Author(s):

Fu-Huan Huang ◽

Po-Lung Cheng ◽

Wen-Hsuan Hou ◽

Yih-Cherng Duh

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Surgical Site Infection ◽

Laparoscopic Hernia Repair ◽

Meta Analysis ◽

Operation Time ◽

Site Infection ◽

Pediatric Inguinal Hernia ◽

Extraperitoneal Approach ◽

Open Hernia Repair

Objective: This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. Summary Background Data: Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. Results: Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: −11.90 min, 95% CI: −16.63 to −7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. Conclusions: LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.

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LAPAROSCOPIC VERSUS OPEN REPAIR OF INGUINAL HERNIA

Sveikatos mokslai ◽

10.5200/sm-hs.2017.006 ◽

2017 ◽

Vol 27 (1) ◽

pp. 28-34

Author(s):

Žilvinas Dambrauskas ◽

Lina Pankratjevaitė ◽

Vaidotas Bogusevičius ◽

Antanas Mickevičius

Keyword(s):

Inguinal Hernia ◽

Laparoscopic Surgery ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Laparoscopic Repair ◽

Open Repair ◽

Laparoscopic Hernia Repair ◽

Laparoscopic Group ◽

Open Hernia Repair

Background and objective. Inguinal hernia repair is one of the most common general surgery procedures. Laparoscopic repair is technically more demanding, though it has been shown to be superior in terms of pain and discomfort, however, there is no apparent difference in recurrence between laparoscopic and open mesh methods of hernia repair. Over the years we see a relatively slow increase of laparoscopic procedures and even scepticism of the patients; thus we decided to test the hypothesis that more demanding and costly laparoscopic surgery has little benefits over the open procedure. The aim of our study was to compare postoperative pain, short- and long-term outcomes after laparoscopic hernia repair and conventional open hernia repair. Results. Laparoscopic procedure was significantly more often performed for the patients, who were younger, had shorter history of disease. The mean operative time for laparoscopic inguinal hernia repair was significantly longer than for open repair (p=0.02). The pain score for laparoscopic surgery was significantly lower according to VAS on day 1, 2, 3 (overall p≤ 0.002). The patients in the laparoscopic group required significantly lower doses of narcotic analgesics on the third postoperative day; the doses of nonsteroidal anti-inflammatory drugs were also significantly lower on the second and third postoperative day in this group. The postoperative hospital stay was shorter after laparoscopic repair (p=0.01). Sixty-four patients (71.11%) completed follow-up at one year after the operation. Nine (14.06%) of them had postoperative complications and eight of them were after open hernia repair. Two patients (3.1%) were re-operated (both patients were treated by Lichtenstein hernioplasty): one for inguinal hernia recurrence, another for testicular necrosis. Conclusions. The patients from laparoscopic group had significantly shorter postoperative pain duration (p=0.019), returned to daily activity slightly earlier and had better satisfaction with the operation comparing with the patients who undergone open surgery (p=0.915, p=0.893), but the duration of the sick leave (time off from work) was similar in both hernia repair group (p=0.260). Data shows that laparoscopic hernia repair has advantages in terms of post-operative pain intensity and duration, as well as risk of complications and patient satisfaction.

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