Technical standardization of laparoscopic herniorraphy in pediatric patients.
BACKGROUND
Laparoscopic inguinal hernia repair is rarely reported in pediatric patients. We report our experience on this topic to show the standardization of the technique.


METHODS
In a 3-year period we operated 315 patients for unilateral inguinal hernia using laparoscopy. Fifty of the 315 patients (15.9%) were younger than 1 year old. The age ranged from 1 month to 8 years (median 3.2) with a median body weight of 14.3 kg. We always used three trocars, and we used the modified laparoscopic herniorraphy according to Montupet. After sectioning the sac distally to the ring, the periorificial peritoneum was closed with a purse-string suture of nonresorbable suture material.


RESULTS
The operating time averaged 25 min. All the procedures were performed in a day-hospital setting. In 123/315 patients (39%), at operation we found a contralateral patency of the processus vaginalis. In these 123 cases we performed a bilateral herniorraphy. In one girl (0.3%) we found a coexistence of oblique external hernia and a direct hernia, and both orifices were sutured in laparoscopy. We recorded only 1 minor complication: a problem with needle extraction. With a minimum follow-up of 1 year, there were 2 recurrences (0.6%).


CONCLUSIONS
We believe that laparoscopic repair of inguinal hernia in expert hands is a safe and effective procedure. It makes it possible to repair all forms of inguinal hernia simultaneously, together with contralateral patencies, which has cemented its role as an alternative to conventional repair.
Esposito
Ciro
C
Department of Pediatrics, Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it
Montinaro
Leonardo
L
Alicchio
Francesca
F
Scermino
Silvia
S
Basile
Angela
A
Armenise
Tommaso
T
Settimi
Alessandro
A
D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D012008:Recurrence; D013536:Suture Techniques; D016896:Treatment Outcome