["No-puncture-laparoscopy" in hernia management in childhood--reliable complement to established therapy concepts].
BACKGROUND
Approximately 50% of children with a clinical unilateral inguinal hernia display a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia. The management of this problem is still controversial. The purpose of this study was to evaluate the usefulness of intraoperative laparoscopy in a non-puncture technique through the opened hernia sack.


METHODS
In 112 children (age 6 months to 7 years) with clinical unilateral hernia laparoscopy (5 mm laparoscope, 30 degrees and 70 degrees). In cases of a wide-open contralateral internal inguinal ring (type III) open surgical exploration was performed.


RESULTS
Nineteen patients (17%) fulfilled the laparoscopic criteria of a type III ring; the diagnose was confirmed during open contralateral exploration. Fourteen of these patients were younger than two years. The median time for laparoscopy was 6 min (3-11 min). No complications associated with the laparoscopy were observed.


CONCLUSIONS
Intraoperative laparoscopy during unilateral hernia repair allows the identification of patients who profit from bilateral open surgery during the same operation with little additional operating time and so far with no resulting complications. Application of this method may avoid a second hospitalization and operation, as well as an unnecessary routine bilateral open exploration. As an additional source of information through excellent visualization of the abdominal cavity, this method proved helpful to examine incarcerated bowel after repositioning.
Birk
D
D
Chirurgische Klinik I, Universität Ulm.
Formentini
A
A
Poch
B
B
Beger
H G
HG
D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery; D020706:Laparoscopes; D008297:Male; D012086:Reoperation