Laparoscopic inguinal hernia repair in children: true herniotomy is more reliable than herniorrhaphy

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Abstract

BACKGROUND: The optimal laparoscopic technique for pediatric inguinal hernia continues to be discussed with a view to its further refinement.

AIM: This study aimed to ascertain the outcomes of two laparoscopic fully intra-corporeal techniques employed in our practice: herniorrhaphy and true herniotomy.

METHODS: A retrospective comparative review of patient outcomes was conducted following laparoscopic groin hernia repair: herniorrhaphy — 1st series and true herniotomy — 2nd series. Patient data was analysed using non-parametric statistics with Mann-Whitney test.

RESULTS: In total there were 328 patients, aged between 2 months and 17 years, with 402 groin hernia defects including metachronous and rare defects. The herniorrhaphy was performed for indirect hernia defects (n=186) and herniotomy — for indirect (n=206) as well as for direct (n=6) and femoral (n=2) defects. Technically, there were no intraoperative complications in any case in either series. Conversion to open procedure was required in one patient of 1st series (0,5%) with giant hernia because of the impossibility to maintain due pneumoperitoneum. The postoperative recovery was prompt and uneventful with restoration of mobility and oral intake within 3–6 hours in all patients with no difference between the series. Adverse postoperative events were noted in 10 patients after herniorrhaphy — hydrocele (n=6; 3.2%) and hernia recurrence (n=4; 2.2%) whereas after herniotomy there was only one case (n=1; 0.5%) of hydrocele and none of recurrence. The overall rate of these complications was significantly lower in the herniotomy series vs herniorrhaphy (p=0.004).

CONCLUSION: Laparoscopic intracorporeal techniques both herniorrhaphy and true herniotomy are safe and effective for pediatric hernia repair. True herniotomy appears to be a more robust technique to minimise incidence of postoperative hydrocele and recurrence.

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About the authors

Anatole M. Kotlovsky

I.S.Turgenev Medical institute of Orel State University

Author for correspondence.
Email: ank424@gmail.com
ORCID iD: 0000-0003-4971-658X
SPIN-code: 9907-2163

MD, Cand. Sci. (Medicine)

Россия, Orel

Oleg L. Chernogorov

Z.I. Krugloy Scientific and Clinical Multidisciplinary Center for Medical Care for Mothers and Children

Email: olch912@mail.ru
ORCID iD: 0000-0001-7162-7263
SPIN-code: 3246-9114

MD

Россия, Orel

Aleksei I. Medvedev

I.S.Turgenev Medical institute of Orel State University

Email: maiorel@yandex.ru
ORCID iD: 0000-0003-1966-3771
SPIN-code: 6153-8947

MD, Cand. Sci. (Medicine)

Россия, Orel

Vladimir I. Kruglyi

I.S.Turgenev Medical institute of Orel State University

Email: pedsurg@mail.ru
ORCID iD: 0009-0001-6061-7788

MD, Cand. Sci. (Medicine)

Россия, Orel

Andrey G. Prityko

V.F. Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: prityko@mail.ru
ORCID iD: 0000-0001-8899-4107
SPIN-code: 5045-6357

MD, Dr. Sci. (Medicine)

Россия, Moscow

References

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2. Fig. 1. Laparoscopic images of intracorporeal herniorrhaphy for the internal inguinal ring (indirect) defect: a and b — applying purse-string suture with inclusion of the transversalis fascia (arrow 1) and the ileo-pubic tract (arrow 2) while sparing the spermatic duct (arrow 3) and the testicular vessels (arrow 4); c and d — completing the closure with intracorporeal knotting, leaving the spermatic duct (arrow 3) and the testicular vessels (arrow 4) noticeably intact.

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3. Fig. 2. Laparoscopic images of intracorporeal herniotomy for the internal inguinal ring (indirect) defect: a and b — the hernia sac excised at the neck while sparing the spermatic duct (arrow 3), the testicular vessels (arrow 4) and the ileo-inguinal nerve; c — the peritoneal defect closure with continuous suture including the transversalis fascia (arrow 1) and the ileo-pubic tract margin (arrow 2); d — completing the peritoneal closure with intracorporeal knotting while visualizing the spermatic duct (arrow 3) and the testicular vessels (arrow 4) clearly intact.

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