Laparoscopic Inguinal Hernia Repair in Infancy and Childhood: A Randomized Controlled Study of Two Different Techniques

Background: Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. Laparoscopic hernia repair in infancy and childhood is still debatable. There are many techniques available for laparoscopic hernia repair in pediatrics. Purpose: to compare laparoscopic intracorporeal purse-string suture ligation of the hernia defect leaving the sac intact versus disconnection of the hernia sac with intracorporeal suture of proximal part. Patients and Methods: A prospective controlled randomized study of laparoscopic repair of congenital inguinal hernia [CIH] was conducted over ninety patients at the Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, over a period of 2 years from April 2014 to April 2016. They were randomized into two equal groups: Group I (n = 45) received Intracorporeal purse string suture ligation of the hernia sac in at IIR leaving the sac intact; and Group II (n = 45) received disconnection of the hernia sac with intracorporeal suture of proximal part at IIR. Inclusion criteria: Bilateral CIH, unilateral CIH with questionable other side, cases of CIH associated with umbilical hernia and parental request. Exclusion criteria: Recurrent cases, complicated cases, hernia of canal of Nuck in females, inguinal hernia with undescended testis, parental refusal. The main outcome measurements were; operative time, hospital stay, postoperative hydrocele formation, recurrence rate, and cosmetic results. Results: This study included 90 patients with 94 hernia defects. Their age ranged from 6 months to 3 years. There were no significant differences regarding the demographic data of the groups. All cases were completed successfully without conversion. There were no statistically significant difference between groups regarding intraoperative complications and hospital stay. There were statistically significant difference in the operative time and post-operative complications between the studied groups. Conclusions: Laparoscopic inguinal hernia repair by disconnection of the hernia sac at the IIR with peritoneal closure is safe and feasible method. It has a lower recurrence rate than the purse string suturing leaving the sac intact. [Yasser Ashour, Mohamed Abd-Alrazek and Rafik Shalaby. Laparoscopic Inguinal Hernia Repair in Infancy and Childhood: A Randomized Controlled Study of Two Different Techniques. Nat Sci 2017;15(2):35-41]. ISSN 1545-0740 (print); ISSN 2375-7167 (online). http://www.sciencepub.net/nature. 7. doi:10.7537/marsnsj150217.07.