Laparoscopic iliopubic tract repair for pediatric inguinal hernia has very low recurrence: an Indian experience

Abstract

Background: The aim of this study is to document results of laparoscopic iliopubic tract (IPT) repair for inguinal hernia in the pediatric age group.

Methods: Hospital records of 190 children who underwent IPT repair between January 2015 and January 2020 were analyzed retrospectively for demographic details, variations between clinical, radiological and laparoscopic diagnosis, associated pathologies, operative time, hospital stay, postoperative complications and follow-up. The internal ring was narrowed by approximating IPT to conjoint tendon using 3-0 polypropylene continuous or interrupted suture.

Results: In total, 238 IPT repairs were done under general anesthesia in 190 children aged between 1 and 17 years. 7.9% of children had phimosis, and three children had hydrocele. Three patients had undescended testis and another three IPT repairs were done in cases who presented with appendicitis. Contralateral patent processus vaginalis (CPPV) was detected at the time of laparoscopy in 18.3% of cases. Thus far, 166 children had been followed, and no recurrence was observed in any of these 96 of whom have completed more than 3 years after their surgery. However, two patients developed hernia on the contralateral side.

Conclusions: Laparoscopy is beneficial to pick up CPPV. Laparoscopic IPT repair for pediatric inguinal hernia is reproducible and safe with the least recurrence reported thus far. However, further follow-up is needed. Moreover, development of contralateral hernia needs to be investigated.

Keywords: gastroenterology; pediatrics.

Figure 1

Port sites used for laparoscopic bilateral iliopubic tract repair. In case of unilateral defect, the opposite port is made little lower.

Figure 2

Laparoscopic view of right (A) and left (B) inguinal rings in a patient with bilateral inguinal hernia.

Figure 3

Peritoneum is being incised lateral to the internal ring, at the neck of the sac (A). Incision is extended along the superior aspect (B), sac is dissected completely (C) and divided (D).

Figure 4

Needle is being introduced lateral to the internal ring (A). The iliopubic tract is approximated to the conjoint tendon from lateral to medial aspect (B, C). Thereafter, sutures are taken in reverse manner to tie the knot at starting point (D).

Figure 5

Peritoneum is being closed from lateral to medial aspect on the right side (A–C). Laparoscopic view of the left side after peritoneal closure (D).