title: Twenty-year experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs.
abstract: The role of laparoscopy in pediatric inguinal hernia (IH) is still controversial. The authors reported their twenty-year experience in laparoscopic IH repair in children.
  
  
  
  In a twenty-year period (1995-2015), we operated 1300 infants and children (935 boys-365 girls) with IH using laparoscopy. The average age at surgery was 18 months (range 7 days-14 years). Body weight ranged between 1.9 and 50 kg (average 9.3). Preoperatively all patients presented a monolateral IH, right-sided in 781 cases (60.1 %) and left-sided in 519 (39.9 %). We excluded patients with bilateral IH and unstable patients in which laparoscopy was contraindicated. If the inguinal orifice diameter was ≥10 mm, we performed a modified purse string suture on peri-orificial peritoneum, in orifices ≤5 mm, we performed a N-shaped suture.
  
  
  
  No conversion to open surgery was reported. In 533 cases (41 %), we found a contralateral patency of internal inguinal ring that was always closed in laparoscopy. In 1273 cases (97.9 %), we found an oblique external hernia; in 21 cases (1.6 %), a direct hernia; and in 6 cases (0.5 %), a double hernia on the same side (hernia en pantaloon). We found an incarcerated hernia in 27 patients (2 %). Average operative time was 18 min (range 7-65). We recorded 5/1300 recurrences (0.3 %), but in the last 950 patients, we had no recurrence (0 %). We recorded 20 complications (1.5 %): 18 umbilical granulomas and two trocars scar infections, treated in outpatient setting.
  
  
  
  On the basis of our twenty-year experience, we prefer to perform IH repair in children using laparoscopy rather than inguinal approach. Laparoscopy is as fast as inguinal approach, and it has the advantage to treat during the same anesthesia a contralateral patency occured in about 40 % of our cases and to treat also rare hernias in about 3 % of cases.
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy. ciroespo@unina.it.
authors: Ciro
authors: C
authors: Esposito
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Maria
authors: M
authors: Escolino
authors: Department of Anaesthesiology, Federico II University of Naples, Naples, Italy.
authors: Giuseppe
authors: G
authors: Cortese
authors: Department of Anaesthesiology, Federico II University of Naples, Naples, Italy.
authors: Gianfranco
authors: G
authors: Aprea
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Francesco
authors: F
authors: Turrà
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Alessandra
authors: A
authors: Farina
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Agnese
authors: A
authors: Roberti
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Mariapina
authors: M
authors: Cerulo
authors: Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
authors: Alessandro
authors: A
authors: Settimi
mesh_terms: D000293:Adolescent; D000758:Anesthesia; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D061887:Conversion to Open Surgery; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007264:Inguinal Canal / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D010537:Peritoneum / Q000601:surgery; D012008:Recurrence; D013536:Suture Techniques
keywords: Children; Contralateral patency; Inguinal hernia; Laparoscopy; Recurrence