Infant hernia....suggestion s please.
| Discussion in 'All Categories' started by Saravana balaji - Apr 9th, 2024 7:15 am. | |
Saravana balaji
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I have a 4month old male child with umbilical hernia and rt inguinal hernia ..... Can I repair both hernia in the same lap sitting ?? If so port positions?? Plan :1 open umbilical hernia, scope through it and 2 additional ports for intracorporeal suturing of rt deep ring and umbilical suturing using suture passer and umbilicoplasty. Plan :2 camera port at palmer point repair both umbilical hernia and rt inguinal hernia using intracorporeal suturing. But umbilicoplasty I have to do seperately. Plan 3 : do open rt inguinal hernia repair and wait for umbilical hernia repair later. |
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re: Infant hernia....suggestion s please.
by Dr Bhalla -
May 26th, 2024
2:57 pm
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Dr Bhalla
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Management of Simultaneous Umbilical and Right Inguinal Hernia in a 4-Month-Old Considerations: Age and Anesthesia: The child's age (4 months) is a significant factor. Prolonged anesthesia should be minimized. Safety and Efficacy: Minimizing the number of surgical interventions is beneficial, provided that it doesn't compromise the safety or the outcomes. Technical Feasibility: Both hernias need adequate repair without compromising the integrity of the abdominal wall or increasing the risk of recurrence. Plan Evaluation Plan 1: Combined Open Umbilical and Laparoscopic Inguinal Repair Advantages: One surgical event. Direct visualization and repair of the umbilical hernia. Disadvantages: Requires proficiency in pediatric laparoscopic surgery. Potential for increased operative time. Technical difficulty in managing both hernias through the umbilicus in an infant. Port Positions: Open umbilical port (site of the hernia). Additional 3 mm ports in the lower quadrants for suturing (one in the left lower quadrant and one in the suprapubic region). Procedure: Open umbilical hernia and insert the scope through the umbilicus. Place additional ports for intracorporeal suturing of the right inguinal hernia. Use a suture passer for umbilical suturing and perform umbilicoplasty. Plan 2: Laparoscopic Repair with Separate Umbilicoplasty Advantages: Laparoscopic visualization for both hernias. Reduced postoperative pain and faster recovery. Disadvantages: Requires two stages if umbilicoplasty is planned separately. Increased operative complexity and time if done in one sitting. Port Positions: Camera port at Palmer’s point (left upper quadrant). Working ports in the lower quadrants (one in the right lower quadrant and one in the suprapubic region). Procedure: Perform laparoscopic repair of both hernias. Perform umbilicoplasty separately if necessary, either in the same session or in a staged manner. Plan 3: Open Right Inguinal Repair and Later Umbilical Repair Advantages: Simplified surgery, especially if the umbilical hernia might close spontaneously. Reduced operative time and anesthesia exposure. Disadvantages: Requires a second surgical intervention if the umbilical hernia does not resolve. Prolonged overall treatment period. Procedure: Open repair of the right inguinal hernia. Observe the umbilical hernia, planning for a potential future repair if necessary. Recommendations: Preferred Approach: Given the child's age and the complexity of dual repairs, Plan 1 or Plan 2 might be more beneficial to avoid a second surgical procedure. If your surgical team has the necessary pediatric laparoscopic expertise, Plan 1 allows for simultaneous repair with cosmetic benefit from the umbilicoplasty. Port Placement: For Plan 1: Umbilical port (primary) and two additional 3 mm ports (one in the left lower quadrant and one in the suprapubic region). For Plan 2: Palmer’s point for the camera and two lower quadrant ports. Considerations: Discuss the potential for spontaneous closure of the umbilical hernia with the parents. Consider a second opinion from a pediatric surgeon if uncertain about the laparoscopic approach. Ultimately, the decision should be based on the surgeon's experience, available resources, and the child's specific circumstances. |
