Pediatric Laparoscopic Inguinal Hernia Repair: A Comparison between 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 pediatric age group, by a randomized comparison. Materials 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 was significantly less. Conclusion: Laparoscopic sac excision in indirect pediatric inguinal hernia is safe. The procedure is not associate TAJ 2020; 33(2): 20-26

Laparoscopic Herniotomy for congenital inguinal hernia: prospective assessment of feasibility and outcome analysis in tertiary center in Nepal

Introduction: Congenital Inguinal hernia (CIH) repair is frequently performed surgical procedures in children. Open herniotomy is standard treatment for CIH. However, in developed countries laparoscopic repair is gaining popularity. The benefits of laparoscopic hernia repair are its safety, cosmetic results, opportunity to repair contralateral patent processus vaginalis (CPPV). The aim of this study was to assess feasibility and outcome of Laparoscopic herniotomy (LH) in tertiary center in Nepal. Methods: This is prospective observational study conducted at Nepal Medical College Teaching Hospital, Pediatric Surgery Unit from 1st November 2015 to 30th October 2016. All children of age greater than six months with CIH were included in this study after consent from parents. Demographic profile, operative findings, postoperative results, complications and recurrences were recorded. Results: We had 60 children, 45 males and 15 females who underwent laparoscopic herniotomy. 33 of them had right, 24 had left and 3 had bilateral hernias. The mean operating time was 30.12 minutes and 35 minutes for unilateral and bilateral hernias respectively. 14 were associated with CPPV and were repaired in same setting. We had one recurrence on right side and were repaired with open herniotomy. Conclusion: Laparoscopic herniotomy is feasible and safe in CIH. It provides better opportunity to diagnose CPPV and repair it. LH has got minimal complication and better cosmetic outcome. Larger studies and longer follow ups are needed to support our results.