title: Two-trocar needlescopic approach to incarcerated inguinal hernia in children.
abstract: BACKGROUND
  Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children.
  
  
  METHODS
  A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting.
  
  
  RESULTS
  In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications.
  
  
  CONCLUSIONS
  The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.
authors.affiliation: Pediatric Surgical Unit, Faculty of Medicine, Al-Azhar University, Nasr City, 11884, Cairo, Egypt. rafikshalaby@hotmail.com
authors.forename: Rafik
authors.initials: R
authors.lastname: Shalaby
authors.forename: Abdul Moniem
authors.initials: AM
authors.lastname: Shams
authors.forename: Soliman
authors.initials: S
authors.lastname: Mohamed
authors.forename: Mohamed
authors.initials: M
authors.lastname: el-Leathy
authors.forename: Medhat
authors.initials: M
authors.lastname: Ibrahem
authors.forename: Gamal
authors.initials: G
authors.lastname: Alsaed
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009339:Needles; D011183:Postoperative Complications; D013525:Surgical Instruments; D016896:Treatment Outcome