Iranian Journal of Pediatrics
Tehran University of Medical Sciences Press
ISSN: 1018-4406 EISSN: 2008-2150
Vol. 20, Num. 3, 2010, pp. 372-373
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Iranian Journal of Pediatrics, Vol. 20, No. 3, July-September, 2010,
pp. 372-373
Experience with a New Technique for Laparoscopic Hernia
Repair in Small Children and Infants
Ahmad
Khaleghnejad Tabari1, MD; Mahmood Saeeda2, MD;
Alireza Mirshemirani1, MD
1Pediatric
Surgery Research Center, Shaheed Beheshti University of Medical Sciences,
Tehran, IR Iran 2Department
of Pediatric Surgery, Milad General Hospital, Social Security Organization,
Tehran, IR Iran
During
recent years, the trend toward laparoscopic approach for hernia repair
in children has been increasingly justified [1,2]. The ability
to detect and repair the contralateral patencies simultaneously, along
with safety of the procedure are the cornerstones of the selection of
the laparoscopic approach as a reliable alternative to the conventional
open techniques[3].
Although
many authors believe that the laparoscopic inguinal hernia repair is
superior to the traditional approach in the view of improved cosmesis
and fewer recurrences, there are still some issues about its popularity,
especially regarding the acceptable cosmetic results, along with the
short operative time and brief hospital stay and the high success rate
of open conventional technique.
We
performed 50 inguinal hernia repairs by laparoscopic technique during
2.5 years from April 2006 to October 2008 in our hospital.
Forty-one
children including 34 males and 7 females underwent operation by this
technique.
Hernia
in 25 cases was right-sided and in 7 left-sided. Two patients had recurrence
following previous hernia repair through groin incision. 32 cases presented
with unilateral hernia and 9 patients had bilateral inguinal hernia.
The
age of the patients ranged from 4 months to 5 years. The median age was
11 months. The mean operative time for unilateral repairs was 20 minutes
and for bilateral ones 35 minutes. The scars on the abdominal wall were
small and minute (one 5mm incision for umbilical port and a 3mm stab
incision ipsilateral to the hernia for working cannula) and the cosmesis
was excellent. There were no intra-operative complications and we had
no conversion. The follow-up rate at six months was 100% and we had no
recurrences or any other complications such as testicular atrophy.
Inguinal
hernia in pediatric age group is a common problem and all the pediatric
surgeons are fully familiar with the various aspects of its traditional
surgical repair through the groin incision which has a high success rate
and acceptable cosmetic results with few complications[4,5].
By
far one of the drawbacks of this conventional technique is its inability
to rule out the contralateral patent processus vaginalis and synchronous
hernia.
With
the advent of minimal access surgery, many pediatric surgeons accepted
it, as an suitable and reliable alternative to previous techniques, considering
its superiority for handling tissues during repair of recurrent inguinal
hernias and also for its capabilities in regard to justifying and managing
the synchronous subtle contralateral hernia[6,7].
However,
there are still some issues about the introduction of laparoscopic inguinal
hernia repair as the gold standard method, specially taking the possible
longer operative time and the inevitable need for three separate ports
which is the case in routine laparoscopic herniotomy techniques into
consideration.
The
modified and new laparoscopic technique employed by the authors has an
acceptable short operative time with only one working trocar located
ipsilateral to the hernia, using extra-corporeal tying, that yields excellent
cosmesis.
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F. Laparoscopic inguinal hernia repair –a prospective personal series
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