Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia.
BACKGROUND
The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children.


METHODS
A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010.


RESULTS
There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy.


CONCLUSIONS
Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting.
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. edwinchan@surgery.cuhk.edu.hk
Kin Wai Edwin
KW
Chan
Kim Hung
KH
Lee
Yuk Him
YH
Tam
Jennifer Dart Yin
JD
Sihoe
Sing Tak
ST
Cheung
Jennifer Wai Cheung
JW
Mou
D002648:Child; D002675:Child, Preschool; D004210:Dissection / Q000295:instrumentation; D004487:Edema / Q000150:complications; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013525:Surgical Instruments