Laparoscopic herniorrhaphy after manual reduction of incarcerated inguinal hernia.
BACKGROUND
After a manual reduction (MR) of an incarcerated inguinal hernia (IIH), it is recommended that an open herniotomy (OH) be performed after a one-day delay because of the postincarceration tissue edema. We assumed that performing laparoscopic herniorrhaphy (LH) shortly after MR reduces the hospital stay for IIH. We compared LH with OH retrospectively. We expected equal results but a shorter hospital stay with LH.


METHODS
From May 2002 to April 2006, 40 successive patients with IIH were admitted. OH was scheduled two days after MR, whereas no delay for performing LH was required. Patients in whom MR failed and who required immediate surgery (n = 4) and patients whose medical condition prevented surgery within the schedule (n = 3) were excluded from the study. Follow-up consisted of an outpatient visit and telephone survey.


RESULTS
Thirty-three patients (31 male, 15 OH, 18 LH) were included. For the LH patients, the median age was 15 (0.7-81) months and that for OH patients was 8.6 (0.6-61) months. For LH patients, weight = 11.5 (3.6-22) kg and for OH patients, weight = 9.8 (3.5-17) kg (p = NS). Median delay from MR to OH was 2 (2-4) days, and from MR to LH median delay was 1 (0-3) day (p < 0.05). Length of the operation was 29 (10-80) min in OH and 39 (20-60) min in LH (p = NS). Total theatre time was 44 (17-111) min in OH and 66 (44-86) min in LH (p < 0.05), and hospital time was 3 (3-6) days in OH and 2 (1-4) days in LH (p < 0.05). Median cost (surgery + hospitalization) of OH was euro 2315 (1910-3530) and that of LH was euro 3215 (2605-3650) (p < 0.05). Median follow-up was 26 (4-49) months, one patient (LH) had re-LH for recurrent hernia.


CONCLUSIONS
After MR, LH can be performed with minimal delay and similar results as OH. Despite increased theatre time and total hospital costs, LH shortened hospital stay.
Koivusalo
A
A
Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
Pakarinen
M P
MP
Rintala
R J
RJ
D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D008297:Male; D011300:Preoperative Care; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics / Q000379:methods; D013997:Time Factors