Characteristics and recent therapeutic trends of pediatric inguinal hernia

Inguinal hernia is one of the most common surgical disease that pediatric surgeons deal with. This article provides an overview of pediatric inguinal hernia and a review of the current evidence about variable laparoscopic operative options and their results. In recent years, the use of laparoscopic procedures has gained increased popularity. Most of the laparoscopic repairing methods for pediatric inguinal hernia have similar results with open surgery when it comes to recurrence rates and complication rates. They have shorter operative time for bilateral hernia, less contralateral metachronous hernia and less invasive for vas deference and testicular vessels. The laparoscopic repair can be an alternative of open repair. Further research comparing the different laparoscopic approaches including long term outcome will be needed.

Laparoscopic exploration in LPEC for children with unilateral inguinal hernia and the clinical value in preventing contralateral metachronous hernia / 中国内镜杂志

Objective?To investigate the application effect of laparoscopic exploration in laparoscopic percutaneous extaperitoneal closure (LPEC) and its value in preventing contralateral metachronous hernia (MCH).?Methods?The clinical data of 300 children with unilateral inguinal hernia treated by open herniorrhaphy (control group) and 200 children with unilateral inguinal hernia treated by LPEC (observation group) were analyzed retrospectively. In the observation group, the condition of contralateral groin was also explored by laparoscopy, and ligation of contralateral patent processus vaginalis (CPPV) was performed while in the control group, there was no exploration during operation. The operation indexes, postoperative complications and the incidence of MCH were compared between groups. The relationships between the occurrence of MCH and CPPV, age was analyzed.?Results?The postoperative pain visual analogue scale (VAS) score, postoperative ambulation time and hospitalization time of the observation group were significantly better than those of the control group (P < 0.05). There was no significant difference between the two groups in operation time and the total incidence of postoperative complications (P > 0.05). The incidence of postoperative MCH in the observation group was significantly lower than that in the control group (1.00% vs 4.67%) (P < 0.05). In the observation group, there were 72 cases of CPPV, the incidence rate of CPPV was 36.00%, and the incidence rate was related to age (P < 0.05). The MCH/CPPV risk ratio (RR) was 0.03, and 1/RR was about 33. Among all of the children, children with MCH and younger than 2 to 4 years old accounted for 43.75% while children of 0.5 to 2 years old accounted for 31.25%.?Conclusion?Compared with open herniorrhaphy, laparoscopic LPEC has characteristics of mild postoperative pain and faster recovery in the treatment of unilateral inguinal hernia, and it can significantly reduce the incidence of MCH. Laparoscopic exploration can accurately find CPPV. Ligation can reduce the incidence of MCH but it may cause excessive medical treatment.