Page 22 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic Herniotomy in Female Children:

Our Experience in 110 Patients

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Chalapathi Gontumukkala , Ramana NG Venkata , Rajeev K Golimi , Veera S Javvadi 4
AbstrAct
Aim of the study: To assess the results and complications of laparoscopic herniotomy in female children using percutaneous internal ring
suturing (PIRS).
Materials and methods: One hundred and ten consecutive female children who were admitted with a unilateral or bilateral inguinal hernia
from January 2015 to June 2018 to a medical college referral hospital were included in the study. The technique used was PIRS, using spinal
needle 23 gaze and 3.0 prolene. All patients were followed up postoperatively. Babies with recurrent hernias and complicated inguinal hernia
were excluded from this study.
Results: A total of 110 female children with unilateral or bilateral inguinal hernia were included in the study. Age ranged from 1 month to 15
years with a mean age of 3 years. The clinically unilateral hernia was present in 80 children but the patent internal ring was present on the
contralateral side in 25 children and was repaired simultaneously. The bilateral inguinal hernia was present in 30 children. The total number of
hernia units was 165. The mean operative time was 15 minutes, ranging from 12 minutes to 20 minutes for unilateral hernia and 15–30 minutes
for a bilateral hernia. The mean postoperative stay was 1 day. The follow-up period ranged from 7 days to 2 years. Two babies had hematoma
at the internal ring during the procedure, subsided with no postoperative sequel. One child developed hernia on contralateral side, who was
operated for contralateral patent ring during repair of an ipsilateral clinical hernia. None other children who were operated for clinical hernia
had a recurrence.
Conclusion: Laparoscopic herniotomy using the technique of PIRS is safe, quick with minimal postoperative pain, and short hospital stay, and
had a very low incidence of recurrence.
Keywords: Hernia, Laparoscopy, Percutaneous internal ring suturing.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1375

IntroductIon
1–4 Department of Paediatric Surgery, Kurnool Medical College,
Inguinal hernias in children are due to the protrusion of viscera
through persistent process vaginalis. Conventional open therapy Kurnool, Andhra Pradesh, India
includes ligation of the sac at the internal ring. The same basic Corresponding Author: Veera S Javvadi, Department of Paediatric
principle is used in laparoscopy also. Conventional open therapy Surgery, Kurnool Medical College, Kurnool, Andhra Pradesh, India,
Phone: +91 9440439674, e-mail: chalagontu@gmail.com
has a high success rate and acceptable cosmetic results with few
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complications. The main drawbacks of conventional open therapy How to cite this article: Gontumukkala C, Venkata RNG, Golimi RK,
are the inability to rule out the contralateral patent processes et al. Laparoscopic Herniotomy in Female Children: Our Experience in
110 Patients. World J Lap Surg 2019;12(2):68–72.
vaginalis and synchronous hernia. Nowadays, laparoscopy in children
is increasingly used to repair inguinal hernias. Several laparoscopic Source of support: Department of Paediatric Surgery, Kurnool Medical
College, Kurnool, Andhra Pradesh, India

techniques have developed over the past two decades aimed at
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improving the outcome. This study is to assess the technique, Conflict of interest: None
results, complications of percutaneous internal ring suturing (PIRS)
with the help of spinal needle 23 gaze, and 3.0 prolene. Procedure

MAterIAls And Methods Laparoscopic repair is performed under general anesthesia. The
patient is positioned supine, often in the Trendelenburg position.
This was a prospective study conducted in the department of The surgeon stands on the side contralateral to the hernia with
pediatric surgery. A total of 1,100 children with inguinal hernia the monitor on the ipsilateral side. The instruments used are 5 mm
were admitted for surgery from January 2015 to June 2018 to a umbilical port for the camera and 3 mm port on the contralateral
medical college referral hospital. Out of the total 1,100 children with iliac fossa for manipulation. The abdomen is insufflated through
inguinal hernia, male children were 990 and female children were the umbilicus, to a pressure of 8–12 mm Hg depending on the size
110. These 110 female children with unilateral or bilateral inguinal of the child. Any hernia contents are reduced before beginning
hernia were chosen for this procedure. Consent was taken from all the repair of the hernia. With laparoscopy, the contralateral side
parents before the procedure. The technique used was PIRS using can be evaluated and bilateral repair performed when necessary.
spinal needle 23 gaze and 3.0 prolene. All patients were followed
up postoperatively. Male children with inguinal hernias and female Following are the steps of the procedure:
babies with recurrent hernias and complicated inguinal hernias • Introduce the 3.0 prolene suture through the barrel of the 22 or
were excluded from this study. 23 gaze spinal needle (Fig. 1).

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