Laparoscopic inguinal hernia repair in the pediatric age group--experience with 437 children.

BACKGROUND/PURPOSE: A retrospective analysis of prospectively collected data of pediatric patients that underwent laparoscopic inguinal hernia repair. MATERIAL AND METHODS: A retrospective review was performed of the prospectively collected data of 576 laparoscopic internal ring closures in 437 children (age, 30 days-11 years; median, 1.9 years) from June 1999 to February 2009. The internal ring was closed with a 3-0 nonabsorbable suture. Both extracorporeal and intracorporeal methods of knotting were used. All patients were asked to return at 1 week and 6 weeks postoperatively for routine follow-up. RESULTS: A contralateral patent processus vaginalis was present in 13% (45/352) of boys and 15% (12/83) of girls on the right side, and 7% (25/352) of boys and 6% (5/83) of girls on the left side. Follow-up range was from 1 week postoperatively to 108 months. There were 14 recurrences (2.4 % [14/576], 11 in boys and on the right side and 3 in girls) and 2 hydroceles 0.35% (2/576). Mean operating time was 23 minutes for unilateral and 29 minutes for bilateral inguinal hernia. There was neither metachronus hernia nor testicular atrophy observed during follow-up. CONCLUSION: Laparoscopic inguinal hernia repair is technically easier, as there is no need to dissect the vas deferens and vessels. The risk of metachronous hernia is reduced, and we believe the cosmetic result is better. Although recurrences were more common early in the series, currently they are much less frequent. Laparoscopic inguinal hernia repair appears to have less morbidity than open herniotomy and can be used as routine procedure in the pediatric age group.

Laparoscopic management of persistent mullerian duct syndrome.

Persistent mullerian duct syndrome (PMDS), characterized by the presence of mullerian structures in a virilized male, frequently presents as undescended testis, either intraabdominal or within a hernial sac. We describe a 10-month-old infant with PMDS successfully managed by the laparoscopic approach. At the age of 1.5 months, the patient presented with a left inguinal hernia and bilateral nonpalpable gonads in another center and underwent left inguinal exploration. The uterus and a gonadlike structure along with the hernia sac were found in the inguinal canal. Left inguinal herniotomy was performed after reduction of the uterus and gonadlike structure. No gonadal biopsy was obtained. The patient was further investigated in the same center. His karyotype was 46,XY. Magnetic resonance imaging of the abdomen and pelvis revealed a uterinelike structure posterior to the urinary bladder, but neither testis nor ovaries were visualized. At 10 months of age, he was referred to our department for further management. A laparoscopic single-stage orchiopexy was performed. Both testes were identified and brought to the scrotum by splitting the uterus in the midline and then bringing the testes with the vas and attached uterine tissue into the scrotum. The aim of placement of well-vascularized testes in the scrotum was achieved as confirmed on follow-up color Doppler ultrasound study 6 months postoperatively, which showed normal vascularity. Laparoscopic surgical techniques for this condition are also discussed.