Laparoscopic approach for inguinal hernia in children: resection without suture.

BACKGROUND/PURPOSE: The laparoscopic treatment of inguinal hernia in children presents a higher frequency of relapse when suture technique procedures are used. Here, we present an alternative technique consisting of laparoscopic resection of the hernia sac without suture according to the physiopathology of pediatric inguinal hernia. METHODS: In prospective studies from June 2006 to January 2011, pediatric patients with a diagnosis of inguinal hernia were subjected to surgery as follows: resection of the hernia sac without suture was performed with a 3-port laparoscopic approach. Age, surgical time, recurrence, and complications were analyzed. RESULTS: We analyzed 285 patients, who ranged from 1 month to 15 years old. They included 233 males, and 52 females. A percentage of 31.92 were bilateral (375 inguinal canals). The surgery time ranged from approximately 5 to 12 minutes. They were followed up 6 to 55 months, with an optimal evolution in 99.2%. Recurrence was observed in only 2 patients (0.53%), both of whom underwent incomplete resection. CONCLUSIONS: In this study, we demonstrate that resection of the hernia sac without sutures allows for the treatment of inguinal hernia with a low recurrence rate.

[Laparoscopic resection of a gastric giant cavernous hemangioma in a child]. / Resección laparoscópica de un hemangioma cavernoso gástrico gigante a un niño.

BACKGROUND: Gastric hemangioma rarely appears during the pediatric age, with only thirteen cases in the medical literature. Its manifestations are digestive bleeding and intestinal obstruction. The bleeding can be severe and for such reasons it is usually necessary to apply surgical procedures. Up until now every case had been treated with resection and reconstruction through open surgery. We present the case of a patient treated successfully through a laparoscopic approach. CLINICAL CASE: 7 year old boy presenting hematemesis and hypovolemic shock, after stabilizing the patient a digestive endoscopy is performed revealing a hemangioma in the gastric fundus. Other injuries were discarded through a magnetic resonance angiography. Through a laparoscopic approach, with a postoperative endoscopic aiding procedure intending to discard affectation on the gastric esophageal junction, a resection with a harmonic scalpel on the lesion and a 2 plane gastric reconstruction was performed. The patient was discharged successfully on the fourth day after the surgery was performed with an 18 month clinical tracing and no further incidence. CONCLUSIONS: Laparoscopic approaches allow a safe gastric hemangioma resection and stomach reconstruction, with a relatively short recovery period and the well known benefits of minimal invasion procedures.