title: Laparoscopic management of recurrent inguinal hernia in childhood.
abstract: BACKGROUND
  Open repair of recurrent inguinal hernias [RIH] in infancy and childhood is difficult and there is definite risk of damaging the vas deferens and testicular vessels. Laparoscopic repair of RIH has the benefit of avoiding the previous operative site. The aim of this study is to present our experience with laparoscopic repair of RIH either after open or laparoscopic hernia repair with stress on technical refinements to prevent recurrence.
  
  
  METHODS
  This is a retrospective study of laparoscopic repair of RIH. Records of 38 patients with 42 recurrent hernial defects that have been subjected to laparoscopic inguinal hernia repair [LIHR] for RIH were reviewed and evaluated. The primary outcome measurements of this study include; operative time and recurrence rate. The secondary outcomes include intraoperative and postoperative complications, hydrocele formation and testicular atrophy.
  
  
  RESULTS
  In this study 38 children with 42 recurrent hernial defects [4 patients had bilateral recurrent hernia] were operated upon laparoscopically. They were 34 males and 4 females with a mean age of 2.54±1.989years (range=0.58-10.00years). In 35 hernial defects the recurrence developed after open herniotomy, while in 7 hernial defects it occurred after laparoscopic repair. All procedures were completed laparoscopically without any conversion and there were no intraoperative or postoperative complications during this study. Mean operating time was 15±2.3minutes for unilateral and 20±1.7minutes for bilateral inguinal hernia. All patients achieved full recovery and were discharged on the same day of admission. Two patients developed hydroceles that responded well to conservative management. At mean follow-up of 12.7±2months (range=8-38.4months), there was no recurrence, no testicular atrophy.
  
  
  CONCLUSIONS
  Laparoscopic repair of RIH in infancy and childhood is an attractive option that avoids the difficulties of redo surgery in scarred operative field with delicate structures liable to injury even with expert operator.
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt. Electronic address: rafikshalaby@hotmail.com.
authors.forename: Rafik
authors.initials: R
authors.lastname: Shalaby
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
authors.forename: Maged
authors.initials: M
authors.lastname: Ismail
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
authors.forename: Samir
authors.initials: S
authors.lastname: Gouda
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
authors.forename: Abdel Aziz
authors.initials: AA
authors.lastname: Yehya
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Gamaan
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
authors.forename: Refaat
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
authors.forename: Sayed
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alazab
mesh_terms: D001284:Atrophy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D006848:Testicular Hydrocele / Q000209:etiology; D013737:Testis / Q000473:pathology / Q000601:surgery; D014649:Vas Deferens
keywords: Childhood; Laparoscopy; Open herniotomy; Recurrent inguinal hernia; Technical refinements