title: Long-term follow-up of laparoscopic transcutaneous inguinal herniorraphy with high transfixation suture ligature of the hernia sac.
abstract: BACKGROUND
  Laparoscopic transcutaneous inguinal hernia repair in children may reduce postoperative pain, improve cosmesis, allow for less manipulation of the cord structures, and offer easy access to the contralateral groin. However, there is concern for unacceptably high recurrence rates when the procedure is generalized. To address this increase in recurrence, in 2011 we described in this journal a modification of the laparoscopic transcutaneous technique that replicates high transfixation ligature of the hernia sac with the aim of inducing more secure healing, preventing suture slippage, and distributing tension across two suture passes. We now describe our long-term follow-up of this novel repair.
  
  
  METHODS
  After obtaining IRB approval, a retrospective chart review and phone follow-up were performed on all patients who underwent laparoscopic transfixation ligature hernia repair between October 2009 and August 2014 (including further follow-up of the 21 patients reviewed in the 2011 report of this technique). Data collection included demographics, laterality of hernia, evidence of recurrence, complications, and time to follow-up.
  
  
  RESULTS
  Median follow-up was 24 months (range 2-52 months). Three pediatric surgeons performed 216 laparoscopic transfixation ligature repairs on 166 patients.
  
  
  METHODS
  mean age 29.5 months (range 1-192 months); male 67.2% and female 32.8%; 4.2% of patients were premature at operation. Repairs were bilateral in 42% of patients, right sided in 34%, and left sided in 24%. Three patients together experienced 4 recurrences, for an overall recurrence rate of 1.8%. Two of the recurrences occurred in a 2-month old syndromic patient with severe congenital heart disease who recurred twice after laparoscopic transfixation ligature repair then subsequently failed an attempt at open repair. Excluding this one outlier patient, the recurrence rate was 0.9%. The complication rate was 1.7% (3 hydroceles and 1 inguinal hematoma; all resolved spontaneously).
  
  
  CONCLUSIONS
  Laparoscopic high transfixation ligature hernia repair can be adopted by surgeons with basic laparoscopic skills, and result in excellent outcomes with acceptable recurrence rates.
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Jaramillo
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Kastenberg
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: James K
authors.initials: JK
authors.lastname: Wall
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Wright
authors.affiliation: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Department of Surgery, Stanford University School of Medicine, Stanford, CA. Electronic address: sdutta1@stanford.edu.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Dutta
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008026:Ligation / Q000379:methods*; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D013536:Suture Techniques; D006848:Testicular Hydrocele / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Children; Herniorrhaphy; Inguinal hernia; Laparoscopic; Pediatric; Recurrence