Laparoscopic inguinal herniorrhaphy in babies weighing 5 kg or less.
BACKGROUND
This retrospective study aimed to evaluate the feasibility, safety, and complication rate of laparoscopic inguinal hernia repair for small babies weighing 5 kg or less compared with the traditional open herniotomy.


METHODS
A retrospective analysis was performed on the surgical charts of 147 infants weighing 5 kg or less who underwent laparoscopic hernia repair. Either a regular 5-mm scope or a microlaparoscope was used for visualization, and 2-mm instruments were used for closure of the inner inguinal ring.


RESULTS
Of the 147 infants (100 boys and 47 girls; 41 bilateral, 77 right-sided, 29 left-sided hernias) 39 (26.5%) presented with an irreducible hernia. The median weight at surgery was 3.9 kg (range, 1.45-5 kg). Of the infants, 11 (7.5%) weighed less than 2.5 kg, and 58 (39.4%) were premature. The median operative time for the bilateral hernia was 20 min. No serious intraoperative surgical complications occurred. Anesthesiologic complications were noted in eight cases. After a median follow-up period of 26 months (range, 6-52 months), 124 children were clinically examined. In the boys, testicular volume and echogenic texture were studied ultrasonographically, and testicular perfusion was measured using the O2C device. Hernia recurrence was observed in four patients (2%). According to a linear regression analysis, the risk of recurrence was increased by 14.16% for children classified as American Society of Anesthesiology (ASA) 3 or more. No cases of testicular atrophy occurred. In five boys, we observed seven cases of high testes requiring subsequent orchiopexy (4% of 172 hernia repairs among the boys). The regression analysis showed that for every 1 kg less body weight, the risk of an undescended testis increased by 65.5%.


CONCLUSIONS
Laparoscopic inguinal hernia repair for babies weighing 5 kg or less is feasible, safe, and perhaps even less technically demanding than open herniotomy.
Department of Pediatric Surgery, University Medical Centre, Langenbeckstrasse 1, 55101, Mainz, Germany. salmai.turial@unimedizin-mainz.de
Salmai
S
Turial
Jan
J
Enders
Kathrin
K
Krause
Felix
F
Schier
D001284:Atrophy; D001835:Body Weight; D003456:Cryptorchidism / Q000453:epidemiology / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013737:Testis / Q000098:blood supply / Q000473:pathology; D016896:Treatment Outcome