Subscribe to RSS
DOI: 10.1055/s-0030-1262793
© Georg Thieme Verlag KG Stuttgart · New York
Surgical Repair of Incarcerated Inguinal Hernia in Children: Laparoscopic or Open?
Publication History
received May 18, 2010
accepted after revision June 18, 2010
Publication Date:
11 October 2010 (online)
![](https://www.thieme-connect.de/media/ejps/201101/lookinside/thumbnails/10.1055-s-0030-1262793-1.jpg)
Abstract
Purpose: The management of Incarcerated Inguinal Hernia (IIH) in children is challenging and may be associated with complications. We aimed to compare the outcomes of laparoscopic vs. open repair of IIH.
Methods: With institutional ethical approval (09SG13), we reviewed the notes of 63 consecutive children who were admitted to a single hospital with the diagnosis of IIH between 2000 and 2008. Data are reported as median (range). Groups were compared by chi-squared or t-tests as appropriate.
Results: · Open repair (n=35): There were 21 children with right and 14 with left IIH. 2 patients also had contralateral reducible inguinal hernia. Small bowel resection was required in 2 children. · Laparoscopic repair (n=28): All children had unilateral IIH (19 right sided, 9 left sided). 15 children (54%) with no clinical evidence of contralateral hernia, had contralateral patent processus vaginalis at laparoscopy, which was also repaired. The groups were similar with regard to gender, age at surgery, history of prematurity, interval between admission and surgery, and proportion of patients with successful preoperative manual reduction. However, the duration of operation was longer in the laparoscopy group (p=0.01). Time to full feeds and length of hospital stay were similar in both groups. Postoperative follow-up was 3.5 months (1–36), which was similar in both groups. 5 patients in the group undergoing open repair had serious complications: 1 vas transaction, 1 acquired undescended testis, 2 testicular atrophy and 1 recurrence. The laparoscopic group had a single recurrence.
Conclusion: Open repair of incarcerated inguinal hernia is associated with serious complications. The laparoscopic technique appears safe, avoids the difficult dissection of an oedematous sac in the groin, allows inspection of the reduced hernia content and permits the repair of a contralateral patent processus vaginalis if present.
Key words
incarcerated inguinal hernia - laparoscopic hernia repair - open hernia repair
References
- 1 Chen LE, Zamakhshary M, Foglia RP. et al . Impact of wait time on outcome for inguinal hernia repair in infants. Pediatr Surg Int. 2009; 25 223-227
- 2 Stylianos S, Jacir NN, Harris BH. Incarceration of inguinal hernia in infants prior to elective repair. J Pediatr Surg. 1993; 28 582-583
- 3 Puri P, Guiney EJ, O’Donnell B. Inguinal hernia in infants: The fate of the testis following incarceration. J Pediatr Surg. 1984; 19 44-46
- 4 Palmer BV. Incarcerated inguinal hernia in children. Ann R Coll Surg Eng. 1978; 60 121-124
- 5 Kaya M, Huckstedt T, Schier F. Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg. 2006; 41 567-569
- 6 Koivusalo A, Pakarinen MP, Rintala RJ. Laparoscopic herniorraphy after manual reduction of incarcerated inguinal hernia. Surg Endosc. 2007; 21 2147-2149
- 7 Schier F. Laparoscopic surgery of inguinal hernias in children – initial experience. J Pediatr Surg. 2000; 35 1331-1335
- 8 Chan KL, Hui WC, Tam PKH. Prospective, randomized, single-center, single-blind comparison of laparoscopic vs. open repair of pediatric inguinal hernia. Surg Endosc. 2005; 19 927-932
- 9 Miltenburg DM, Nuchtern JG, Jaksic T. et al . Laparoscopic evaluation of the pediatric inguinal hernia – a meta-analysis. J Pediatr Surg. 1998; 33 874-879
- 10 Lau ST, Lee YH, Caty MG. Current management of hernias and hydroceles. Sem Pediatr Surg. 2007; 16 50-57
- 11 Ron O, Eaton S, Pierro A. Systematic review of the risk of developing a metachronous contralateral inguinal hernia in children. Br J Surg. 2007; 94 804-811
- 12 Hall NJ, Pacilli M, Eaton S. et al . Recovery after open vs. laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet. 2009; 373 ((9661)) 390-398
Correspondence
Prof. Agostino Pierro
UCL Institute of Child Health & Great Ormond Street
Hospital for Children Unit of Paediatric Surgery
London
United Kingdom
Phone: +44 2079 052 641
Fax: +44 2074 046 181
Email: pierro.sec@ich.ucl.ac.uk