The role of laparoscopic procedure against inguinal hernia comparing with open procedure

BackgroundLaparoscopic approach, especially laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia (IH) is widely spread but few studies have compared its invasiveness with that of conventional approach (OPEN). This study compared the role and postoperative early phase symptoms of LPEC with OPEN at our institute.MethodsThe records of 940 IH patients from 2014 to 2019 were analyzed on the basis of age, sex, method of surgery, pre- and post-operative diagnosis, postoperative symptoms, and complications.ResultsThe OPEN group comprised 393 males, of which 44 were diagnosed with contralateral hernia (7.1%). In the LPEC group, 158 males had an average age of 3.88 years. The contralateral patent processus vaginalis (CPPV) was identified in 148 patients during operation. OPEN operation time for patients aged <1 year was 42.7 minutes, vs 33.4 minutes for LPEC. The two groups experienced comparable paces of fever and first oral intake time; however, pain and recurrence rate were greater in the LPEC group.ConclusionLPEC can be performed to avoid contralateral occurrence; surgical time is reduced for patients aged <1 year. However, the reduced invasiveness of LPEC compared to that of OPEN did not minimize postoperative symptoms or complications.

Laparoscopic iliopubic tract repair for pediatric inguinal hernia has very low recurrence: an Indian experience

BackgroundThe aim of this study is to document results of laparoscopic iliopubic tract (IPT) repair for inguinal hernia in the pediatric age group.MethodsHospital records of 190 children who underwent IPT repair between January 2015 and January 2020 were analyzed retrospectively for demographic details, variations between clinical, radiological and laparoscopic diagnosis, associated pathologies, operative time, hospital stay, postoperative complications and follow-up. The internal ring was narrowed by approximating IPT to conjoint tendon using 3-0 polypropylene continuous or interrupted suture.ResultsIn total, 238 IPT repairs were done under general anesthesia in 190 children aged between 1 and 17 years. 7.9% of children had phimosis, and three children had hydrocele. Three patients had undescended testis and another three IPT repairs were done in cases who presented with appendicitis. Contralateral patent processus vaginalis (CPPV) was detected at the time of laparoscopy in 18.3% of cases. Thus far, 166 children had been followed, and no recurrence was observed in any of these 96 of whom have completed more than 3 years after their surgery. However, two patients developed hernia on the contralateral side.ConclusionsLaparoscopy is beneficial to pick up CPPV. Laparoscopic IPT repair for pediatric inguinal hernia is reproducible and safe with the least recurrence reported thus far. However, further follow-up is needed. Moreover, development of contralateral hernia needs to be investigated.

The meaning of laparoscopic procedure against inguinal hernia

Background Laparoscopic approach, especially laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia (IH) is widely spread but few studies have compared its invasiveness with that of conventional approach (POTTS). This study compared the role and invasiveness of LPEC with POTTS at our institute. Material and methods The records of 940 IH patients from 2014 to 2019 were analyzed on the basis of age, sex, method of surgery, pre- and post-operative diagnosis, postoperative symptoms, and complications. Results The POTTS group comprised 393 males, of which 44 were diagnosed with contralateral hernia (7.1%). In the LPEC group, 158 males had an average age of 3.88 years. The contralateral patent processus vaginalis (CPPV) was identified in 148 patients during operation. POTTS operation time for patients aged < 1 year was 42.7 minutes, vs 33.4 minutes for LPEC. The two groups experienced comparable paces of fever and first oral intake time; however, pain and recurrence rate were greater in the LPEC group. Conclusion LPEC can be performed to avoid contralateral recurrences; surgical time is reduced for patients aged < 1 year. However, the reduced invasiveness of LPEC compared to that of POTTS did not minimize postoperative symptoms or complications.

Comparing the Incidences of Occult Contralateral Hernia under Laparo-Endoscopic Techniques and of Contralateral Metachronous Hernia after a Unilateral Groin Hernia Repair in Open Technique

The aim of this study was to evaluate the utility of immediate repair of a contralateral occult hernia at the same time as incipient hernia repair. A total of 693 patients were diagnosed preoperatively with a unilateral groin hernia from January 2006 to December 2017. The open technique was used for 541 patients, and the laparo-endoscopic technique was used for 152 patients. The incidences of occult contralateral hernia confirmed during surgery under laparo-endoscopic techniques and those of contralateral metachronous hernia after a unilateral groin hernia repair with open technique were compared. Fifty-one (9.4%) of 541 patients underwent a contralateral metachronous hernia repair after unilateral groin hernia repair. Twenty-three (15.1%) of 152 patients had occult contralateral hernias using laparo-endoscopic techniques. There was a significant difference in the incidence of contralateral metachronous hernia and that of occult contralateral hernia (P = 0.02). It is concluded that finding and repairing an occult contralateral hernia at the time of laparoendoscopic technique has the advantage of avoiding a second operation. However, it has been considered overtreatment to repair all patients with an occult contralateral hernia.

Three Years Experience of Inguinal Hernia in Children in BSMMU

Objective: The aim of this study is to evaluate the management of inguinal hernias in children as a day case surgery in elective basis.Methods: From July 2011 to June 2014, 141 infants and children with inguinal hernias were seen, operated on, and followed up as outpatient procedure in the Department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh (BSMMU) Age, sex, side of hernia, presence of an associated hydrocele/ undescended testes/ VPshunt, occurrence of contralateral hernia, clinical aspects of these patients, type of surgery, mortality, and mobidity were studiedResults: The ages ranged from 2months to 14 years (mean age, 6.28 years) with a male-to female ratio of 3:1. There were 59.6% right, 34.8% left, and 5.7% bilateral hernias (all are indirect variety).The most common associated anomaly was hydrocele in 29(20.8%)patients, undescended testis in 9(6.5%) patients and in 4(2.8%) patients had ventriculoperitoneal shunt. The content of the hernial sac in 56(39.7%) patients were omentum and next were intestine in 30(21.3%) patients. Overall, there were 13 (9.2%) sliding hernias. Among them in five case of boys four (80%) patients contents were cecum and one (20%) patient was sigmoid colon. In case of girls, contents were ovaries in all eight patients. Contralateral groin exploration was not done of any patients at the initial hernia repair. There were recurrences in 2(1.4%) patients, 13(9%) patients developed wound infections, and 21(15%) patients had scrotal haematocele. There were no postoperative deaths. A contralateral hernia developed in three (2%) children within one year after the initial repair.Conclusions: Inguinal hernia is a common surgical condition in children. Elective surgery is associated with minimal morbidity. A routine contralateral groin exploration is not done at the initial hernia repairJ. Paediatr. Surg. Bangladesh 6(2): 34-38, 2015 (July)