Page 25 - World Journal of Laparoscopic Surgery

Laparoscopic Herniotomy in Female Children: Our Experience in 110 Patients
results higher rates of recurrence have been reported with a laparoscopic
A total of 110 female children with unilateral or bilateral inguinal procedure. Schier et al. and Chinnaswamy et al. reported the
recurrence rate of 3.1–4.4% after intraperitoneal Z-type suture
hernia were included in the study. Age ranging from 1 month to or with simple purse-string suture. 14–16 This is in contrast with
15 years. The mean age of 3 years. The clinically unilateral hernia our low recurrence rate of 0.6% after laparoscopic PIRS. We had
was present in 80 children. The right inguinal hernia was seen one baby developing clinical hernia (0.6%) who was operated for
in 50 and left inguinal hernia was seen in 30 children. During contralateral patent ring during ipsilateral clinical hernia. The reason
laparoscopy for unilateral hernias, the patent internal ring was for recurrence may be due to a small patent contralateral ring and
present on the contralateral side in 25 children (31.25%) and was was technically difficult to encircle ring completely with suture.
repaired simultaneously. The bilateral inguinal hernia was present Verma et al. operated 150 cases of inguinal hernias and
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in 30 children. A total number of hernia units was 165. Preoperative hydroceles using laparoscopic herniotomy performing at the
ultrasonography was done in all patients to confirm the diagnosis. neck of the sac. The proximal part of peritoneum was closed with
The mean operative time was 15 minutes, ranging from 12 to nonabsorbable suture. The mean operative time was 25 minutes for
20 minutes for unilateral hernia and 15 to 30 minutes for a bilateral unilateral and 34.8 minutes for bilateral hernias. They have reported
hernia. The mean postoperative stay was 1 day, ranging from the recurrence rate of 1.33% and a conversion rate of 0.66%.
1 day to 3 days. All patients were followed up postoperatively. The Spurbeck et al., Kastenberg et al., and others 8,18–21 used
follow-up period ranged from 7 days to 2 years. Two babies had laparoscopic-assisted extraperitoneal circuit suture and reported
hematoma at the internal ring during the procedure and subsided the recurrence rate ranging from 0 to 4.3%. Some other authors 22–25
with no postoperative complications. One child had prolene stitch claim the lowest rate of recurrence with a laparoscopic technique
granuloma during follow-up 2 months postoperatively which was involving complete division and then stitching of the hernia sac
removed. One baby developed hernia on the contralateral side who at an internal inguinal ring. They have reported a recurrence rate
was operated for the contralateral patent ring during the repair ranging from 0% to 1.3% which is comparable with our recurrence
of ipsilateral clinical hernia (0.6%). None other children who were rate of 0.6%. The low incidence rate in children with PIRS is due to
operated for clinical hernia had a recurrence.
tying the knot outside the peritoneal cavity more securely after
desufflation, when compare with intracorporeal suturing in an
dIscussIon insufflated abdomen where the positive pressure is working against
The incidence of indirect inguinal hernia in careful controlled the closure of the ring.
3
population studies is 1–5% with male-to-female ratio is 8:1–10:1. conclusIon
The incidence of bilateral inguinal hernia is greater in female
4
patients in all age groups with a reported incidence of 20–50%. Laparoscopic herniotomy using the technique of PIRS using spinal
Injury to the reproductive organs during herniotomy in female needle 23 gaze is safe, quick with minimal postoperative pain
patients is extremely low so some surgeons advocate bilateral and short hospital stay, had the least rate of complications and
exploration in all female patients. associated with a very low incidence of recurrence.
Laparoscopic repair for inguinal hernias in pediatric patients was
5
first described by El-Gohary. Laparoscopy-assisted extracorporeal references
6
suturing was first described by Prasad et al. Lee and Yeung used a 1. Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles.
specially designed herniotomy hook to place suture extraperitoneal Pediatr Clin North Am 1998;45(4):773–789. DOI: 10.1016/S0031-
7
around the internal ring and tie it subcutaneously. Percutaneous 3955(05)70044-4.
internal ring suturing (extracorporeal) was first described by 2. Lukong CS. Surgical techniques of laparoscopic inguinal hernia repair
8
Patkowski et al. They used 18 gaze needle and 2.0 nonabsorbable in children: a critical appraisal. J Surg Tech Case Rep 2012;4(1):1–5.
DOI: 10.4103/2006-8808.100343.
suture to accomplish the procedure. We have modified this 3. Cox JA. Inguinal hernia of childhood. Surg Clin North Am
technique that we use 23 gaze spinal needle and 3.0 prolene. The 1985;65(5):1331–1342. DOI: 10.1016/S0039-6109(16)43742-4.
main advantage of laparoscopy is the inspection of contralateral 4. Tackett LD, Breuer CK, Luks FL, et al. Incidence of contralateral inguinal
ring and the diagnosis of ipsilateral hernia and repair of both hernia: a prospective analysis. J Pediatr Surg 1999;34(5):684–687. DOI:
simultaneously. 10.1016/S0022-3468(99)90356-1.
A contralateral patient process vaginalis was seen in 31.25% of 5. El-Gohary MA. Laparoscopic ligation of inguinal hernia in girls. Pediatr
our children in contrast with Rathauser and Rowe et al. who have Endosurg Innov Tech 1997;1(3):185–188. DOI: 10.1089/pei.1997.1.185.
reported contralateral patent process vaginalis in 50–90% of their 6. Prasad R, Lovvorn HN, Wadie GM, et al. Early experience with
patients. 9,10 Two babies had hematoma during the procedure but needleoscopic inguinal herniorrhaphy in children. J Pediatr Surg
2003;38(7):1055–1058. DOI: 10.1016/S0022-3468(03)00191-X.
subsided postoperatively without any complications. 7. Lee KH, Yeung CK. Laparoscopic surgery in newborns and infants: an
The reported recurrence rates after conventional open update. HK J Paediatr 2003;8:327–335.
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herniorrhaphy among children range from 0.8 to 3.8%. The 8. Patkowski D, Czernik J, Chrzan R, et al. Percutaneous internal ring
technical errors for the recurrence are (1) failure to find the hernial suturing: a simple minimally invasive technique for inguinal hernia
sac, (2) insufficient low-level ligation of the sac, (3) injury to the floor repair in children. J Laparoendosc Adv Surg Tech A 2006;16(5):
of the inguinal canal due to operative trauma, (4) failure to close 513–517. DOI: 10.1089/lap.2006.16.513.
the internal ring in girls, and (5) postoperative wound infection and 9. Rathauser F. Historical overview of the bilateral approach to pediatric
hematoma. 11,12 All these technical problems for recurrence can be inguinal hernias. Am J Surg 1985;150(5):527–532. DOI: 10.1016/0002-
9610(85)90430-1.
avoided by laparoscopy. 13 10. Rowe MI, Copelson LW, Clatworthy HW. The patent process vaginalis
Though laparoscopic herniotomy theoretically provides high and the inguinal hernia. J Pediatr Surg 1969;4(1):102–107. DOI:
ligation of the hernia sac more proximally than does open repair, 10.1016/0022-3468(69)90189-4.

World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019) 71