Laparoscopic pediatric inguinal hernia repair: no ligation, just resection.

BACKGROUND: There have been descriptions of several techniques for congenital inguinal hernia (CIH) repair in the pediatric population by doing high ligation of the sac, without a definitive advantage over the open procedure. High recurrence rates have been reported with using these minimally invasive techniques in which the patent processus vaginalis has been ligated and left in place completely or partially. METHODS: With approval of the ethics committee, a proper informed consent was obtained. During July 2003 to April 2008, we performed the inguinal hernia repair on 91 patients (76 males and 15 females), using a laparoscopic technique in which we completely resected the patent processus vaginalis and the parietal peritoneum surrounding the internal inguinal ring. This allowed the peritoneal scar tissue to close the area of the ring. Also, this scarring occurs in the extent of the inguinal canal where the dissection took place, therefore causing the same peritoneal scarring and sealing of the inguinal floor. In this series, a purse string was done only in the cases with an internal ring wider than 10 mm. RESULTS: There were no conversions. Operative time was in the range of 35-72 minutes (average, 40). Close follow-up in the clinic has been 5 months to 4 years without a single recurrence. In 4 cases, 3 months later, we did a laparoscopic evaluation of the contralateral side due to associated cryptorchidism, in which we were able to confirm a complete closure of the interior inguinal ring. Two small hematomas were followed until they were gone, without further need for intervention. DISCUSSION: No recurrences have been observed. We conclude that laparoscopic repair of CIH is feasible using this technique of complete resection of the processus vaginalis and surrounding parietal peritoneum. This series does not conclude on the need for the internal ring to be closed when found to be wider than 10 mm.

Incidence and management of the inguinal hernia during laparoscopic orchiopexy in palpable cryptoorchidism: preliminary report.

During the laparoscopic approach of undescended testis, an associated inguinal hernia is a frequent finding that must be treated at the same time. The objective of this presentation is to show the incidence and management of the inguinal hernia that were found during laparoscopic orchidopexy, reporting how the scar tissue will join the edges of the canal and the parietal peritoneum will grow above. Between January 1999 and December 2002, 31 patients with 33 palpable and nonpalpable undescended testes were treated by laparoscopic orchidopexy. Patients were between 6 months and 9 years. We used four ports, and 2 mm instrument. When an associated inguinal hernia were found we only removed the membranes of the processus vaginalis and did not close the defect. All cases were treated by the same surgeon. The average surgical time was 50 min that included the orchiopexy and the treatment of the associated inguinal hernia. We found inguinal hernia in 23 cases (69.9%). We did not find any inguinal hernia in the opposite side of the undescended testis. In two patients with bilateral undescended testis that were approached in two stages 3 months later we confirmed the closure of the hernia defect. These 23 patients have 21.5 months average follow up and confirm no recurrence. With an average follow up of 21.5 months, we found no inguinal hernia in any of the patients. A larger volume study with longer follow up is needed to confirm that there is no need for closure of the internal inguinal ring during laparoscopic orchidopexy.