Page 16 - WJOLS - Surgery Journal

AA Kareem, KM Juma’a
enters the deep ring and because no need for repair we avoid with laparoscopy which shows in more than 1% of patients no
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unnecessary disruption of the external ring and unnecessary hernial opening is found. Regarding recurrence rate, this still
exploration of the lower part of the canal. ranges from 0.4 to 4.8% in laparoscopic hernia in pediatrics 15
while in our study there was no recurrence. Also in laparoscopy,
RESULTS AND DISCUSSION there is a chance of abdominal visceral injury especially to the
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bladder, complications with CO and technical difficulties
Both groups, A and B tolerated the surgery very well with no especially in the early age group. 2
need for strong analgesia postoperatively such as opiate, But still recurrent hernia in the pediatric age group is very
paracetamol syrup or tablets being simple and we did not give difficult doing an interior (open) approach and there is a high risk
any antibiotics with no incidence of wound infection. The only
complication was scrotal edema in about 50% of group A which of damaging the vas deferens and testicular vessels during
resolved spontaneously within a few days. dissection of a previously opened hernia, so laparoscopic
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The incidence of hernia in different age groups was repair is the preferred operation for recurrent inguinal hernia
illustrated in Figure 1 which clearly shows a higher incidence in in children after an open repair. Also a laparoscopic approach
children less than 6 years (group A). can show both deep rings and in one study they found that 26%
One year follow-up shows no recurrence and the wound in of boys presented with unilateral inguinal hernia. They had also
group A after 3 weeks cannot be found easily as there is little wide open contralateral deep ring and 11% of female also. 19
scaring. The patients in both groups were dealt with as day So the optimal treatment of inguinal hernia has been
case surgery and discharged after a few hours with no significant controversial for decades since the advent of minimally invasive
complications. surgery laparoscopic techniques have added to the contro-
The surgical technique used in the present study was versy. We can say that our method is not superior to any other
illustrated in Figures 2A to E. In this study I tried to show that method but we did the best for our patients with fewer facilities
minimal invasive technique is also minimal access surgery in a very bad security state and in between gushes of
although it is nonlaparoscopic. I am not doing a comparative emergencies due to explosion, bombs and road traffic accidents.
study between open and laparoscopic technique but trying to Finally we did this number of cold cases with great care and
choose the safest, cheapest, and lowest recurrence technique. delicate dealing with patients and tissues.
So we can use our experience and skill to decrease the cost
firstly by depending for the diagnosis on a full history and CONCLUSION
physical examination without the need for other investigations
such as ultrasound, which might mislead us although some Laparoscopic inguinal hernia repair in children is not the most
studies show that ultrasound in experienced hands, may give superior minimal invasive technique. Open surgery can be done
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an accuracy rate up to 96%. We decrease the cost and the in a less invasive manner with less cost, fewer complications,
time of operation by doing our surgery without laparoscope. maintaining the tactile sensation of a surgeon with most delicate
The study also shows zero negative exploration in comparison and pleasurable surgery.

Fig. 1: Incidence of inguinal hernia in infants, child and adolescence

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