Laparoscopic hernia repair in infancy and childhood: evaluation of 2 different techniques.

PURPOSE: Laparoscopic hernia repair in infancy and childhood is still debatable. There are many techniques available for laparoscopic hernia repair in children. The objective of this study was to compare intracorporeal suturing and knotting with extracorporeal knotting for repair of congenital inguinal hernia in infants and children about operative time, recurrence rate, hydrocele formation, and postoperative cosmetic results. A randomized controlled study was carried out in the Pediatric Surgery Unit of Al-Azhar University Hospitals (Cairo, Egypt) over a 3-year period. PATIENTS AND METHODS: One hundred fifty patients with congenital inguinal hernia were randomized into 2 equal groups (n = 75). Group A was subjected to intracorporeal purse string suture around the internal inguinal ring (IIR) using 2 needle holders. Group B was subjected to insertion of purse string suture around IIR using a Reverdin needle (RN) and extracorporeal knotting. Inclusion criteria included bilateral inguinal hernia, recurrent hernia, hernia in obese children, incarcerated hernia, and ipsilateral hernia with questionable hernia on the contralateral side. Exclusion criteria included unilateral inguinal hernia and hernia with undescended testicles. The main outcome measurements were operative time, length of hospital stay, postoperative hydrocele formation, recurrence rate, and cosmetic results. RESULTS: There were no significant differences about age, sex, and mode of presentation between both groups. All cases were completed successfully without conversion. There were significant statistical differences in the operative time, recurrence rate, and cosmetic results between the studied groups, whereas there were no significant statistical differences in the hospital stay and postoperative hydrocele formation. CONCLUSION: Laparoscopic hernia repair by RN is an effective method of hernia repair in infants and children. It resulted in a marked reduction of operative time and excellent cosmetic results with low recurrence.

A new simplified technique for needlescopic inguinal herniorrhaphy in children.

BACKGROUND: Needlescopic techniques have been used recently in repairing inguinal hernias (IHs), which made this type of surgery more feasible and less invasive. The technique is being developed further. OBJECTIVE: The objective of this study was to describe and assess the results that can be achieved by using a new simplified technique (Reverdin needle) in needlescopic inguinal herniorrhaphy in children. PATIENTS AND METHODS: All patients with symptomatic IH confirmed by clinical examination were subjected to elective needlescopic herniorrhaphy. One hundred fifty patients with 186 groin hernias, from 2 hospitals in Egypt and Saudi Arabia, in the period from October 1999 to May 2002, were assigned to needlescopic inguinal herniorrhaphy using Reverdin needle. Reverdin needle was used to insert a purse-string suture around the internal inguinal ring to be tied extracorporeally. RESULTS: A total of 186 inguinal hernial defects in 150 children were repaired successfully. There were 130 males and 20 females with a mean age of 20.58 +/- 21 months (range, 8-96 months). Right-sided IH was present in 86 patients (57.33%); among these patients, an opened internal inguinal ring was found and repaired in 12 cases (8%). Left-sided IH was present in 30 (20%), bilateral hernia in 19 cases (12.67%), and recurrent IH in 20 cases (10%). The mean duration of surgery was 8.7 +/- 1.18 minutes for unilateral and 12.35 +/- 2 minutes for bilateral hernia repair. There were no intraoperative or postoperative complications. The mean hospital stay was 6 +/- 1.21 hours. CONCLUSION: The new technique had all the advantages of needlescopic herniorrhaphy in children (less invasive, less pain, short hospital stay) combined with the advantages of reduced operating time, simplicity, and feasibility. It may be preferable to the intracorporeal suturing and knot tying. However, it needs long-term follow-up.