One trocar needlescopic assisted inguinal hernia repair in children: a novel technique.

BACKGROUND: Inguinal hernia repair using a percutaneous internal ring suturing technique is an effective alternative technique to conventional laparoscopic hernia repair. It is one of the most commonly used approaches for laparoscopic hernia repair in children. However, most percutaneous techniques have utilized extracorporeal knotting of the suture and burying the knot subcutaneously. This approach has several drawbacks. The aim of this study is to present a modified technique for single cannula needlescopic assisted hernia repair in children. PATIENTS AND METHODS: Three-hundred and fifty-seven patients with 397 indirect inguinal hernias underwent a one port needlescopic assisted inguinal hernia repair. The open internal inguinal ring [IIR] was closed using an 18-gauge epidural needle [EN], a 14-gauge venous access cannula [VAC], and a homemade suture device. Saline was injected extraperitoneally around the IIR for hydrodissection. The main outcome measurements were: feasibility, safety of the technique, operative time, recurrence rate, and cosmetic results. RESULTS: This prospective study was conducted on 357 patients at Al-Azhar, Alexandria, and Mansoura University Hospitals during the period from June 2012 to October 2015. There were 286 males and 71 females. The mean age was 2.6±1.3years (range=4months to 6years). One-hundred and ninety-eight patients presented with a right-sided inguinal hernia, 119 patients with a left-sided hernia, and 40 patients with bilateral inguinal hernia. The mean operative time was 12.6±1.7min (range=8-15min) for unilateral cases and 18.6±1.7min (range=14-20min) for the bilateral repairs. No wound complications or umbilical hernias developed. The mean follow-up period was 18.6±1.2months (range=11-36months). During the follow-up period, no recurrence was detected, and the scars were nearly invisible. CONCLUSION: This preliminary study shows that a single port needlescopic assisted hernia repair in infants and children is a very promising technique to achieve nearly scarless surgery. The procedure is very safe, rapid, easy to learn, and reproducible.

Laparoscopic inguinal hernia repair; experience with 874 children.

BACKGROUND: Laparoscopic inguinal hernia repair (LIHR) in children has become an alternative to the open procedure. It is gaining popularity with more and more studies supporting its feasibility, safety, and efficacy. This is a retrospective study to present our experience with children who underwent LIHR. PATIENTS AND METHODS: A total of 1184 inguinal hernias were repaired laparoscopically in 874 children. They were 703 boys and 171 girls. Their mean age was 2.9 ± 2.1 years (range, 6-108 months). Six-hundred and twenty four opened internal inguinal rings (IIRs) were closed by transperitoneal purse string suture technique (TPP) and 560 opened IIRs were closed by percutaneous purse string suture with lateral umbilical ligament enforcement using Reverdin Needle (RN) technique. RESULTS: All cases were completed laparoscopically without conversion. There were no serious intraoperative complications. Mean operating time, in TPP technique, was 15 ± 2.3 minutes for unilateral and 20 ± 1.7 minutes for bilateral inguinal hernia, while the mean operating time, in RN technique, was 8.7 ± 1.18 minutes for unilateral and 12.35 ± 2 minutes for bilateral hernia repair. The contralateral patent processus vaginalis (PPV) was present in 176 (20% of cases). Follow-up to date is 10-140 months (mean 80 ± 2.1 months). In the early stage of this study, the recurrence rate was 1.13%. In the last 450 cases, no recurrence occurred. Hydroceles occurred in 0.58% and no testicular atrophy or iatrogenic ascent of the testis. CONCLUSIONS: LIHR can be a routine procedure with results comparable to those of open procedures. Both recurrence and operative time are nearly equal or even less than that for the open procedure after gaining a learning curve and modifications of the techniques.

Laparoscopic Hernia Repair versus Open Herniotomy in Children: A Controlled Randomized Study.

Background. Laparoscopic hernia repair in infancy and childhood is still debatable. The objective of this study is to compare laparoscopic assisted hernia repair versus open herniotomy as regards operative time, hospital stay, postoperative hydrocele formation, recurrence rate, iatrogenic ascent of the testis, testicular atrophy, and cosmetic results. Patients and Methods. Two hundred and fifty patients with inguinal hernia were randomized into two equal groups. Group A was subjected to laparoscopic inguinal hernia repair. Group B was subjected to open herniotomy. The demographic data were matched between both groups. Assessment of the testicular volume and duplex assessment in preoperative, early, and late postoperative periods were done. Results. All cases were completed successfully without conversion. The mean operative time for group A was 7.6 ± 3.5 minutes, 9.2 ± 4.6 minutes and 11.4 ± 2.7 minutes, for unilateral hernia, unilateral hernia in obese child, and bilateral hernia, respectively. The recurrence rate was 0.8% in group A, whereas in group B the recurrence rate was 2.4%. Conclusion. Laparoscopic hernia repair by RN is an effective line of hernia repair. It resulted in marked reduction of operative time, low rate of recurrence, no testicular atrophy, no iatrogenic ascent of the testis, and excellent cosmetic results.

Laparoscopic mesh rectopexy for complete rectal prolapse in children: a new simplified technique.

PURPOSE: Rectal prolapse in children without underlying conditions is usually a self-limiting problem and requires no surgical treatment. For children with persistent rectal prolapse, a variety of surgical procedures have been described with success. Recently, there are many reports addressing the successful use of different laparoscopic approaches for complete rectal prolapse. We present a novel simplified laparoscopic technique for management of those patients. The aim of this study is to evaluate the results that can be achieved by using this technique in management of persistent complete rectal prolapse in children. METHODS: We reviewed the reports of 680 patients with primary complete and partial rectal prolapse over the period from August 2000 to August 2008. Fifty-two patients with complete primary rectal prolapse refractory to medical treatment for 2 years underwent a novel simplified technique for laparoscopic mesh rectopexy. RESULTS: Conservative management was successful with no recurrences in 628 patients (92.4%) while 52 (7.6%) patients did not respond to conservative management at a median follow-up period of 2 years. They were 35 males and 17 females. Their ages ranged from 2 to 14 years (mean 6). All patients were subjected to laparoscopic mesh rectopexy successfully without any conversion. The mean duration of surgery was 40 min. No intraoperative complications were reported, but one patient developed postoperative constipation that responded well to conservative treatment. The mean postoperative hospitalization was 2 days. Two cases were lost to follow-up, while the others were available for 36 months. There was no recurrence. CONCLUSION: Laparoscopy mesh rectopexy is safe, rapid, effective technique. It improved functional outcome without recurrence. It is associated with minimal postoperative pain and short hospital stay with excellent cosmoses.