Medium-Term Outcomes of the Godoy Burnia Repair: Durability of a Sutureless Laparoscopic Inguinal Hernia Repair in Girls.

Background: Several methods to repair pediatric inguinal hernias utilizing a minimally invasive technique have been developed over the decades. These methods often involve passage of suture through the peritoneum at the level of the inguinal ring. We previously described the Godoy Burnia, a laparoscopic, sutureless, cautery-only inguinal hernia repair (IHR), and this follow-up study provides longer term data for this emerging surgical technique. Methods: After institutional review board approval, a single-centered retrospective review was performed of female pediatric patients with Godoy Burnia repair from 2014 to 2021. Demographics, operative details, and outcomes were reviewed. Technique: Through a single umbilical incision, a 3 mm port and camera and 3 mm Maryland dissector are placed into the abdomen. The Maryland dissector grasps the hernia sac, everts it, and brings it into the abdomen. Electrocautery is applied to allow scarring and closure of the inguinal ring. Results: Sixty-nine hernia repairs were performed on 44 patients with ages 5 days to 16 years (average 3.9 years) and weighing 2-70 kg (average 16 kg). Average follow-up was 52.8 months, and average operative times were 14/16 minutes for unilateral/bilateral repair, respectively. Twenty-two percent of hernias were found at time of another surgery and repaired. One recurrence (1.45%) in a 16-year-old patient, and 2 patients with other short-term complications. Conclusions: Godoy Burnia, a single-incision, sutureless, laparoscopic IHR in girls, is an acceptable alternative surgical technique with a low complication and recurrence rate. The longer follow-up in this study demonstrates the durability of the repair in most age groups, and decreased operative times suggest a favorable learning curve.

Thoracoscopic approach for complications after esophageal atresia repair: initial experience.

INTRODUCTION: Improvements in technology and health care have helped reduce morbidity and mortality in patients with esophageal atresia. However, postoperative complications such as dehiscences, strictures, and recurrent fistulas still occur in a large percentage of patients. Here, we present our initial experience using the thoracoscopic approach for complications after esophageal atresia repair. METHODS: We retrospectively analyzed the medical records of patients who developed complications after esophageal atresia repair and underwent thoracoscopic reoperation at two centers. Anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula were assessed as complications after esophageal atresia repair. RESULTS: We reoperated on four patients (range of age 3 days - 2 years) by thoracoscopy. Two patients who had undergone thoracoscopic atresia repair presented with anastomotic dehiscence. The anastomoses were thoracoscopically reconstructed without tension. One patient had undergone thoracoscopic atresia repair presented with esophageal stricture refractory to endoscopic dilatations. Thoracoscopic esophagoesophagostomy was performed in this 2-year-old patient. One patient who had undergone esophageal atresia repair and tracheoesophageal fistula closure by thoracotomy presented with a recurrent fistula at 1 year of age. The patient underwent thoracoscopic fistula closure with a 5-mm endostapler. All patients remain asymptomatic after reoperation. CONCLUSIONS: Reoperation after esophageal atresia repair is challenging and carries a relatively high risk of developing complications. Compared to conventional surgery, the thoracoscopic approach in experienced hands offers better visualization and more accurate dissection and drainage of the thoracic cavity. Therefore, we want to encourage the use of thoracoscopy in the treatment of complications after esophageal atresia repair.

Thoracoscopic esophagoesophagostomy for a refractory stricture in a patient with esophageal atresia.

Anastomosis stricture is a well-known complication after esophageal atresia repair. Endoscopic dilatation is the gold standard treatment for esophageal stenosis. However, surgical interventions are indicated for refractory cases. We present a 2-year-old girl with esophageal stricture refractory to regular endoscopic dilatation after esophageal atresia repair that underwent thoracoscopic stricture resection and reanastomosis. Although thoracoscopic approach is widely used for esophageal atresia repair, this approach has not been used before for the treatment of anastomosis stricture.

The Burnia: Laparoscopic Sutureless Inguinal Hernia Repair in Girls.

INTRODUCTION: Laparoscopic inguinal hernia repair in children is in evolution. Multiple methods of passing the suture around the peritoneum at the level of the internal inguinal ring exist. Cauterization of the peritoneum at the internal ring is thought to increase scarring and decrease recurrence. We have employed a sutureless, cautery only, laparoscopic single port repair of inguinal hernias and patent processus vaginalis (PPV) in girls. METHODS: After institutional ethical review was obtained, a retrospective review of sutureless laparoscopic inguinal hernia repairs in girls by 4 surgeons at separate institutions was performed. Patient demographics, intraoperative findings, and postoperative outcomes were recorded and analyzed. The technique involves an umbilical 30° camera and either a separate 3 mm stab incision in the midclavicular line or a 3 mm Maryland grasper placed next to the camera, and the distal most portion of the hernia sac is grasped and pulled into the abdomen and cauterized obliterating the sac. RESULTS: Eighty inguinal hernias were repaired using this technique in 67 girls between July 2009 and September 2015. The ages and weights ranged from 1 month to 16 years and from 2 to 69 kg, respectively. There was one conversion to open approach because an incarcerated ovary was too close to the ring. A single umbilical incision was utilized in 85%. Fifty-seven percent patients had hernias on the right whereas 42% had hernias on the left. Of the patients with presumed unilateral hernias, 22 patients were found to have PPV and were treated through the same incisions, 17/22 were found during a contralateral hernia surgery and 5/22 were found incidentally during appendectomy. Average operative time for unilateral and bilateral hernias was 22 minutes (5-38 minutes) and 31 minutes (11-65 minutes), respectively. No patient required a hospital stay because of the hernia repair. At an average of 25 months follow-up (1.6-75 months), there were no recurrences. The only complication was a single lateral port site hernia on a 2 kg, former 24 week postmenstrual age girl before adapting the technique to single-site surgery for all. CONCLUSIONS: Laparoscopic sutureless inguinal hernia repair is safe and effective in girls of all ages. The single-site modification allows for superior cosmetic result and lower complication profile. The Burnia allows for adequate treatment of unilateral and bilateral inguinal hernias with a single incision in the umbilicus.