title: Laparoscopic percutaneous inguinal hernia repair in children: review of technique and comparison with open surgery.
abstract: Minimally-invasive approaches for inguinal hernia repair have evolved from conventional laparoscopy requiring placement of three ports and intracorporeal suturing to simple, one and two port extraperitoneal closure techniques. We utilize a single port laparoscopic percutaneous repair (LPHR) technique for selected children requiring operative intervention for inguinal hernia. We suspect that compared to open surgery, LPHR offers shorter operative duration with comparable safety and efficacy. Our objectives are to (1) illustrate this technique and (2) compare operative times and surgical outcomes in patients undergoing LPHR versus traditional open repair.
  
  
  
  We reviewed operative times, complications, and recurrence rates in 38 patients (49 hernias) who underwent LPHR at our institution between January 2010 and September 2013. These data were compared with an age-, gender-, weight-, and laterality-matched cohort undergoing open repair during the same 3 year period. All cases were performed by a pediatric urologist or pediatric surgeon.
  
  
  
  Thirty-eight patients with a median age of 21.5 months underwent LPHR, and 38 patients with a median age of 23 months underwent open repair. In both groups, 27/38 patients (71%) had unilateral repairs, and 11/38 patients (29%) had bilateral repairs. For unilateral procedures, average operative duration was 25 min for LPHR and 59 min for OHR (p < 0.001). For bilateral procedures, average operative duration was 31 min for LPHR and 79 min for OHR (p < 0.001). There were no intraabdominal injuries in either group. In the LPHR group, there were no vascular or cord structure injuries and no conversions to open technique. Median follow-up was 51 days for the LPHR group and 47 days for the OHR group (p = 0.346). No hernia recurrence was observed in either group.
  
  
  
  In select patients, LPHR is an efficient, safe, and effective minimally invasive alternative to OHR, with reduced operative times but without increased rates of complications or recurrences. The technique has a short learning curve and is a practical alternative to OHR for pediatric urologists who infrequently utilize pure laparoscopic technique.
authors.affiliation: University of Virginia Children's Hospital, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: mdt4r@virginia.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Timberlake
authors.forename: Troy A
authors.lastname: Sukhu
authors.affiliation: Connecticut Children's Medical Center, University of Connecticut, Hartford, CT, USA. Electronic address: kherbst@connecticutchildrens.org.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Herbst
authors.affiliation: University of Virginia Children's Hospital, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: skr3f@virginia.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Rasmussen
authors.affiliation: University of Virginia Children's Hospital, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: STC2U@hscmail.mcc.virginia.edu.
authors.forename: Sean T
authors.initials: ST
authors.lastname: Corbett
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Extraperitoneal; Inguinal hernia; Laparoscopic; Minimally invasive; Pediatric; Percutaneous