Management of Pediatric Inguinal Hernias in the Era of Laparoscopy: Results of an International Survey

Augusto Zani; Simon Eaton; Michael Hoellwarth; Prem Puri; Juan Tovar; Guenter Fasching; Pietro Bagolan; Marija Lukac; Rene Wijnen; Joachim Kuebler; Giovanni Cecchetto; Risto Rintala; Agostino Pierro

doi:10.1055/s-0033-1354586

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2014; 24(01): 009-013
DOI: 10.1055/s-0033-1354586

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Management of Pediatric Inguinal Hernias in the Era of Laparoscopy: Results of an International Survey

Augusto Zani

¹Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom

²Department of Pediatric Surgery, Sapienza University of Rome, Rome, Italy

,

Simon Eaton

¹Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom

,

Michael Hoellwarth

³Department of Pediatric and Adolescents Surgery, Medical University of Graz, Graz, Austria

,

Prem Puri

⁴Department of Pediatric Surgery, National Children's Research Centre, Dublin, Ireland

,

Juan Tovar

⁵Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Guenter Fasching

⁶Department of Pediatric Surgery, Klagenfurt General Hospital, Klagenfurt, Austria

,

Pietro Bagolan

⁷Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy

,

Marija Lukac

⁸Department of Pediatric Surgery, Faculty of Medicine, University Children's Hospital, Belgrade, Serbia

,

Rene Wijnen

⁹Department of Pediatric Surgery, Erasmus MC-Sophia in Erasmus MC Sophia Childrens' Hospital, Rotterdam, The Netherlands

,

Joachim Kuebler

¹⁰Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany

,

Giovanni Cecchetto

¹¹Department of Pediatric Surgery, University Hospital of Padua, Padova, Italy

,

Risto Rintala

¹²Department of Pediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland

,

Agostino Pierro

¹Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom

¹³Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada

› Author Affiliations

Abstract

Aim The aim of the study is to present views of pediatric surgeons on the optimal approach to inguinal hernias in children.

Methods A questionnaire was submitted to participants of EUPSA-BAPS 2012 and it was returned by 187 responders (85% senior surgeons) from 46 (27 European) countries.

Main Results Approximately 80% of the responders work in centers treating more than 100 cases/year. Approximately 79% of the responders routinely perform laparoscopy for other conditions, but of these, only 22% of the responders routinely perform laparoscopic inguinal hernia repair. Open approach is preferred by 83% of the responders. Of these, 79% of the responders favor unilateral approach, 12% of the responders contralateral, and 9% of the responders contralateral laparoscopic exploration via hernial sac. Considered advantages are the less risk of recurrence (66%), less abdominal organ injury (31%), less vas/vessel injury (25%), and speed (16%). Laparoscopic approach is preferred by 17% of the respondents, of whom 58% perform laparoscopy at all ages, 15% only in younger than 1-year-old infants. Approximately 81% of the responders offer laparoscopy to both sexes, and 17% only in girls. Only 15% would do laparoscopy after incarceration. Purse string is the most popular (58%), then laparoscopic-guided percutaneous closure (28%), “flip-flap” (6%), or other techniques (8%). Proficiency is achieved after 50 (14%), 25 (48%), 10 (32%), or 5 (6%) laparoscopic hernia repairs. Considered advantages are less metachronous contralateral hernias (57%), better cosmesis (41%), easier technique (34%), less vas/vessel injury (31%), and less postoperative pain (22%). A total of 50 responders are planning to start laparoscopic hernia repairs.

Conclusions Most pediatric surgeons favor open unilateral inguinal hernia repair. The role of laparoscopy in inguinal hernias is still controversial and yet to be accepted even amongst pediatric surgeons expert in laparoscopy.

Keywords

herniotomy - herniorrhaphy - minimal invasive surgery - Europe

Full Text

References

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