Laparoscopic diagnosis and repair of pediatric femoral hernia. Initial experience of four cases

Abstract

Femoral hernias are often misdiagnosed and treated as inguinal hernias. Thus, laparoscopic groin exploration may be a valuable means of evaluating children with presumed recurrent inguinal hernias. This study describes the feasibility of laparoscopic groin exploration and femoral hernia repair in children. Four children (aged 2, 2, 3, and 17 years) with reported unilateral recurrent inguinal hernias underwent diagnostic laparoscopy via a 4-mm pediatric laparoscope. Contralateral defects were visualized in all four patients; there were three femoral hernias and one direct inguinal hernia. None of the contralateral defects had been suspected clinically. Of the seven femoral defects, five were repaired laparoscopically. One patulous defect was repaired by reapproximating the iliopubic tract to Cooper's ligament and overlaying a preperitoneal Teflon felt(R) patch. The other four defects were repaired using a Teflon felt(R) plug and preperitoneal patch. A total of three ports were required in each patient (umbilical, suprapubic, and one in between). Two femoral defects in one patient required open repair because a large lipoma prevented adequate visualization and diagnosis. The direct inguinal hernia was also repaired using the open technique. Laparoscopic groin exploration and femoral hernia repair in pediatric patients is safe and technically feasible. Its advantages, however, such as superior diagnostic ability and simultaneous bilateral tension-free repair, need to be validated with a larger study and longer follow-up.