Experience with a New Technique for Laparoscopic Hernia Repair in Small Children and Infants

During recent years, the trend toward laparoscopic approach for hernia repair in children has been increasingly justified [1,2]. The ability to detect and repair the contralateral patencies simultaneously, along with safety of the procedure are the cornerstones of the selection of the laparoscopic approach as a reliable alternative to the conventional open techniques[3]. Although many authors believe that the laparoscopic inguinal hernia repair is superior to the traditional approach in the view of improved cosmesis and fewer recurrences, there are still some issues about its popularity, especially regarding the acceptable cosmetic results, along with the short operative time and brief hospital stay and the high success rate of open conventional technique. We performed 50 inguinal hernia repairs by laparoscopic technique during 2.5 years from April 2006 to October 2008 in our hospital. Forty-one children including 34 males and 7 females underwent operation by this technique. Hernia in 25 cases was right-sided and in 7 leftsided. Two patients had recurrence following previous hernia repair through groin incision. 32 cases presented with unilateral hernia and 9 patients had bilateral inguinal hernia. The age of the patients ranged from 4 months to 5 years. The median age was 11 months. The mean operative time for unilateral repairs was 20 minutes and for bilateral ones 35 minutes. The scars on the abdominal wall were small and minute (one 5mm incision for umbilical port and a 3mm stab incision ipsilateral to the hernia for working cannula) and the cosmesis was excellent. There were no intra-operative complications and we had no conversion. The follow-up rate at six months was 100% and we had no recurrences or any other complications such as testicular atrophy. Inguinal hernia in pediatric age group is a common problem and all the pediatric surgeons are fully familiar with the various aspects of its traditional surgical repair through the groin incision which has a high success rate and acceptable cosmetic results with few complications[4,5]. By far one of the drawbacks of this conventional technique is its inability to rule out the contralateral patent processus vaginalis and synchronous hernia. With the advent of minimal access surgery, many pediatric surgeons accepted it, as an suitable and reliable alternative to previous techniques, considering its superiority for handling tissues during repair of recurrent inguinal hernias and also for its capabilities in regard to justifying and managing the synchronous subtle contralateral hernia[6,7]. However, there are still some issues about the introduction of laparoscopic inguinal hernia repair as the gold standard method, specially taking the possible longer operative time and the inevitable need for three separate ports which is the case in routine laparoscopic herniotomy techniques into consideration. The modified and new laparoscopic technique employed by the authors has an acceptable short operative time with only one working trocar Letter to Editor Iran J Pediatr Sep 2010; Vol 20 (No 3), Pp: 372-373