| Peer-Reviewed

Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures

Received: 22 September 2020     Accepted: 6 October 2020     Published: 13 October 2020
Views:       Downloads:
Abstract

Introduction: There have been multiple descriptions for the laparoscopic repair of inguinal hernia in children. Except for one, they all involve a suture ligation of the internal ring. Our concern is that suture ligation of the internal ring can injure the vas deferens, gonadal vessels, or cause unnecessary bleeding. We report the results of our laparoscopic inguinal hernia repairs, where we incise the peritoneum of the internal ring, and dissect the tunica vaginalis for 1 cm. We do not suture ligate the internal ring. This includes patients who underwent laparoscopic evaluation and treatment for intraabdominal testicles, and thus have 6 month laparoscopic follow-up of those patients having a staged orchiopexy. Study design: We reviewed the charts from 2005 to 2016 of all patients with CPT codes 54692 (laparoscopic orchiopexy) and 49650 (laparoscopic inguinal hernia). During laparoscopy for the nonpalpable testicle, we proceeded to either a one stage or 2 stage orchiopexy. When we observed inguinal hernia opening on the contralateral side of the undescended testicle, we repaired it by incising around the internal ring, and carefully excising the tunica vaginalis from the internal ring for a distance of 1 cm, leaving the internal oblique muscle to heal together, and peritoneum to resurface the area, without using sutures. (This is the same as is done for the laparoscopic orchiopexy side). In those patients with a staged orchiopexy, and we reevaluated the hernia sight for closure. Results: We reviewed charts of 87 patients with ages ranging from 3 months to 10 years. Eighteen of these had bilateral laparoscopic orchiopexy, 38 had left, and 24 had right. We performed 21 bilateral laparoscopic hernia repairs, 27 had left only, and 18 had right only. Of those patients with hernias, 11 hernias were found on the side opposite an undescended testis. In 4 patients we had the opportunity to perform a second stage orchiopexy six months later and observed the inguinal ring had closed. Follow up was at least 6 months for all patients, and no clinical hernias resulted. Conclusion: Laparoscopic inguinal hernia repair in children can be successfully and safely performed by excising the hernia sac (patent processus vaginalis) from the inguinal canal, and does not require suture ligation of the internal ring.

Published in International Journal of Clinical Urology (Volume 4, Issue 2)
DOI 10.11648/j.ijcu.20200402.19
Page(s) 73-76
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Laparoscopic Inguinal Hernia, Laparoscopic Orchiopexy, Pediatric

References
[1] Palmer, LS.; Rastinehad, A. Incidence and concurrent laparoscopic repair of intra-abdominal testis and contralateral patent processus vaginalis. Urology, August 2008 72 (2): 297-299, http: //dx.doi.org/10.1016/j.urology.2007.12.099.
[2] Blackburn, SC; Adams, SD; and Mahomed, AA. Risk of hernia occurrence where division of an indirect inguinal sac without ligation is undertaken. Journal of Laparoendoscopic & Advanced Surgical Techniques. September 2012, 22 (7): 713-714. doi: 10.1089/lap.2012.0011.
[3] Davies, DA.; Rideout, DA.; Clarke, SA. The International Pediatric Endosurgery Group Evidence-Based Guideline on Minimal Access Approaches to the Operative Management of Inguinal Hernia in Children. Journal of Laparoendoscopic & Advanced Surgical Techniques. January 2017, ahead of print. doi: 10.1089/lap.2016.0453.
[4] Riquelme, M; Aranda, A; Riquelme-Q, Mario. Laparoscopic pediatric inguinal hernia repair: no ligation, just resection. Journal of Laparoendoscopic & Advanced Surgical Techniques. January 2010, 20 (1): 77-80. doi: 10.1089/lap.2008.0329.
[5] Tamaddon, H; Phillips, JD; Nakayama, DK. Laparoscopic evaluation of the contralateral groin in pediatric inguinal hernia patients: a comparison of 70- and 120-degree endoscopes. Journal of Laparoendoscopic & Advanced Surgical Techniques. December 2005, 15 (6): 653-660. doi: 10.1089/lap.2005.15.653.
[6] Kokorowski PJ, wang HH, Routh JC, Hubert KC, Nelson CP. Evaluation of the contralateral inguinal ring in clinically unilateral inguinal hernia. A systematic review and met-analysis. Hernia 2014; 18: 311-324.
[7] Shalaby R, Ismail M, Dorgham A, Hefny K, Alsaied G, Gabr K, Abelaziz M. Laparoscopic hernia repair in infancy and childhood: evaluation of 2 different techniques. J Pediatr Surg 2010 Nov; 45 (11): 2210-6.
[8] Esposito, C.; Escolino, M.; Cortese, G. et al. Twenty-year experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs. Surg Endosc (2017) 31: 1461. doi: 10.1007/s00464-016-5139-8.
[9] Grimsby, GM.; Keays, MA.; Villanueva, C.; Bush, NC.; Snodgrass, WT.; Gargollo, PC.; Jacobs, MA. Non-absorbable sutures are associated with lower recurrence rates in laparoscopic percutaneous inguinal hernia ligation. J Pediatr Urol. 2015 Oct; 11 (5): 275. doi: 10.1016/j.jpurol.2015.04.029. Epub 2015 Jun 14.
[10] McClain, L., Streck, C., Lesher, A. et al. Laparoscopic needle-assisted inguinal hernia repair in 495 children. Surg Endosc (2015) 29: 781. doi: 10.1007/s00464-014-3739-8.
[11] Thomas, DT.; Göcmen, KB.; Tulgar, S.; Boga, I. Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases. J Pediatr Surg. 2016 Aug; 51 (8): 1330-5. doi: 10.1016/j.jpedsurg.2015.11.024. Epub 2015 Dec 11.
[12] Borkar, NB.; Pant, N; Ratan, S; Aggarwal, SK. Laparoscopic repair of indirect inguinal hernia in children: does partial resection of the sac make any impact on outcome? Journal of Laparoendoscopic & Advanced Surgical Techniques. March 2012, 22 (3): 290-294. doi: 10.1089/lap.2011.0259.
[13] Pant N, Aggarwal SK, Ratan SK. Laparoscopic repair of hernia in children: Comparison between ligation and nonligation of sac. J Indian Assoc Pediatr Surg 2014; 19: 76-9. doi: 10.4103/0971-9261.129597.
[14] Weaver KL, Poola AS, Gould JL, Sharp SW, St Peter SD, Holcomb GW 3rd. The risk of developing a symptomatic inguinal hernia in children with an asymptomatic patent processus vaginalis. J Pediatr Surg. 2017 Jan; 52 (1): 60-64. doi: 10.1016/j.jpedsurg.2016.10.018. Epub 2016 Oct 28. PMID: 27842956.
[15] Centeno-Wolf N, Mircea L, Sanchez O, Genin B, Lironi A, Chardot C, Birraux J, Wildhaber BE. Long-term outcome of children with patent processus vaginalis incidentally diagnosed by laparoscopy. J Pediatr Surg. 2015 Nov; 50 (11): 1898-902. doi: 10.1016/j.jpedsurg.2015.07.001. Epub 2015 Jul 4.PMID: 6233492.
Cite This Article
  • APA Style

    William Kagetsu Bukowski, Timothy Paul Bukowski. (2020). Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures. International Journal of Clinical Urology, 4(2), 73-76. https://doi.org/10.11648/j.ijcu.20200402.19

    Copy | Download

    ACS Style

    William Kagetsu Bukowski; Timothy Paul Bukowski. Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures. Int. J. Clin. Urol. 2020, 4(2), 73-76. doi: 10.11648/j.ijcu.20200402.19

    Copy | Download

    AMA Style

    William Kagetsu Bukowski, Timothy Paul Bukowski. Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures. Int J Clin Urol. 2020;4(2):73-76. doi: 10.11648/j.ijcu.20200402.19

    Copy | Download

  • @article{10.11648/j.ijcu.20200402.19,
      author = {William Kagetsu Bukowski and Timothy Paul Bukowski},
      title = {Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures},
      journal = {International Journal of Clinical Urology},
      volume = {4},
      number = {2},
      pages = {73-76},
      doi = {10.11648/j.ijcu.20200402.19},
      url = {https://doi.org/10.11648/j.ijcu.20200402.19},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20200402.19},
      abstract = {Introduction: There have been multiple descriptions for the laparoscopic repair of inguinal hernia in children. Except for one, they all involve a suture ligation of the internal ring. Our concern is that suture ligation of the internal ring can injure the vas deferens, gonadal vessels, or cause unnecessary bleeding. We report the results of our laparoscopic inguinal hernia repairs, where we incise the peritoneum of the internal ring, and dissect the tunica vaginalis for 1 cm. We do not suture ligate the internal ring. This includes patients who underwent laparoscopic evaluation and treatment for intraabdominal testicles, and thus have 6 month laparoscopic follow-up of those patients having a staged orchiopexy. Study design: We reviewed the charts from 2005 to 2016 of all patients with CPT codes 54692 (laparoscopic orchiopexy) and 49650 (laparoscopic inguinal hernia). During laparoscopy for the nonpalpable testicle, we proceeded to either a one stage or 2 stage orchiopexy. When we observed inguinal hernia opening on the contralateral side of the undescended testicle, we repaired it by incising around the internal ring, and carefully excising the tunica vaginalis from the internal ring for a distance of 1 cm, leaving the internal oblique muscle to heal together, and peritoneum to resurface the area, without using sutures. (This is the same as is done for the laparoscopic orchiopexy side). In those patients with a staged orchiopexy, and we reevaluated the hernia sight for closure. Results: We reviewed charts of 87 patients with ages ranging from 3 months to 10 years. Eighteen of these had bilateral laparoscopic orchiopexy, 38 had left, and 24 had right. We performed 21 bilateral laparoscopic hernia repairs, 27 had left only, and 18 had right only. Of those patients with hernias, 11 hernias were found on the side opposite an undescended testis. In 4 patients we had the opportunity to perform a second stage orchiopexy six months later and observed the inguinal ring had closed. Follow up was at least 6 months for all patients, and no clinical hernias resulted. Conclusion: Laparoscopic inguinal hernia repair in children can be successfully and safely performed by excising the hernia sac (patent processus vaginalis) from the inguinal canal, and does not require suture ligation of the internal ring.},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures
    AU  - William Kagetsu Bukowski
    AU  - Timothy Paul Bukowski
    Y1  - 2020/10/13
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijcu.20200402.19
    DO  - 10.11648/j.ijcu.20200402.19
    T2  - International Journal of Clinical Urology
    JF  - International Journal of Clinical Urology
    JO  - International Journal of Clinical Urology
    SP  - 73
    EP  - 76
    PB  - Science Publishing Group
    SN  - 2640-1355
    UR  - https://doi.org/10.11648/j.ijcu.20200402.19
    AB  - Introduction: There have been multiple descriptions for the laparoscopic repair of inguinal hernia in children. Except for one, they all involve a suture ligation of the internal ring. Our concern is that suture ligation of the internal ring can injure the vas deferens, gonadal vessels, or cause unnecessary bleeding. We report the results of our laparoscopic inguinal hernia repairs, where we incise the peritoneum of the internal ring, and dissect the tunica vaginalis for 1 cm. We do not suture ligate the internal ring. This includes patients who underwent laparoscopic evaluation and treatment for intraabdominal testicles, and thus have 6 month laparoscopic follow-up of those patients having a staged orchiopexy. Study design: We reviewed the charts from 2005 to 2016 of all patients with CPT codes 54692 (laparoscopic orchiopexy) and 49650 (laparoscopic inguinal hernia). During laparoscopy for the nonpalpable testicle, we proceeded to either a one stage or 2 stage orchiopexy. When we observed inguinal hernia opening on the contralateral side of the undescended testicle, we repaired it by incising around the internal ring, and carefully excising the tunica vaginalis from the internal ring for a distance of 1 cm, leaving the internal oblique muscle to heal together, and peritoneum to resurface the area, without using sutures. (This is the same as is done for the laparoscopic orchiopexy side). In those patients with a staged orchiopexy, and we reevaluated the hernia sight for closure. Results: We reviewed charts of 87 patients with ages ranging from 3 months to 10 years. Eighteen of these had bilateral laparoscopic orchiopexy, 38 had left, and 24 had right. We performed 21 bilateral laparoscopic hernia repairs, 27 had left only, and 18 had right only. Of those patients with hernias, 11 hernias were found on the side opposite an undescended testis. In 4 patients we had the opportunity to perform a second stage orchiopexy six months later and observed the inguinal ring had closed. Follow up was at least 6 months for all patients, and no clinical hernias resulted. Conclusion: Laparoscopic inguinal hernia repair in children can be successfully and safely performed by excising the hernia sac (patent processus vaginalis) from the inguinal canal, and does not require suture ligation of the internal ring.
    VL  - 4
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Department of Biology, Georgetown University, Washington, The United States

  • Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, The United States

  • Sections