Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children.
OBJECTIVE
To describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children.


METHODS
In our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8months to 2.5years; median, 15months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent.


RESULTS
The TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30min (range, 25-40min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported.


CONCLUSIONS
Our preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results.
Department of Pediatric Surgery, Xuzhou Central Hospital, Jiangsu Province, China. Electronic address: wxz613@126.com.
Xuewu
X
Zhou
Department of Pediatric Surgery, Xuzhou Central Hospital, Jiangsu Province, China.
Lei
L
Peng
Department of Pediatric Surgery, Xuzhou Central Hospital, Jiangsu Province, China.
Yongliang
Y
Sha
Department of Pediatric Surgery, Taizhou Hospital, Zhejiang Province, China.
Daiqiang
D
Song
D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus
Incarceration of inguinal hernia; Infant; Laparoscopic repair of inguinal hernia; Reduction; TUES