Preliminary experience of one-trocar laparoscopic herniorrhaphy in infants and children

Abstract

Objective: Laparoscopy is an alternative procedure for pediatric inguinal hernia, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports. The aim of this study was to evaluate the preliminary results of one-trocar laparoscopic herniorrhaphy in infants and children.

Methods: Between April 2007 and March 2010, 216 infants and children treated were retrospectively reviewed. Under laparoscopic guidance, the hernia defect was closed extracorporeally by a nonabsorbable suture, which was introduced into the abdomen by an 18-gauge vascular access on one side of the hernia defect and withdrawn on the opposite side by a homemade hook-pin through a stab incision. Preperitoneal hydrodissection was performed during the procedure. Being a developing technique, multiple linear regressions were used to model markers for the operating time, including descriptive data, diameter of scope, operation findings, and the procedural volume.

Results: A total of 308 procedures were successfully performed among 214 patients (99.1%) and the mean operating time was 42.9 ± 24.7 minutes (range: 9-255 minutes). Additional working instruments were necessary in 7 patients (3.3%). Only 2 (0.9%) recurrences were observed during this period. Male gender (β = 7.507, P = .001), prematurity (β = 10.051, P = .004), presence of incarcerated hernia (β = 12.188, P = .016), and both sides simultaneous operation (β = 7.057, P = .001) would increase the operating time, while being independent of age, weight, presence of sliding hernia, and diameter of scope. However, the operating time may decrease with procedural volume (β = -0.119, P < .001).

Conclusions: Without assistant working instrument, laparoscopy-assisted extracorporeal ligation of the hernia defect may be safely performed in most infants and children. The use of preperitoneal hydrodissection and extraperitoneal knot-tying could tautly enclose the hernia defect without peritoneal gaps and approach an accepted recurrence rate.