Publication:

Management of inguinal hernia in children: a single center experience of 490 patients

Background To evaluate 490 consecutive children who underwent hernia repair over a 3-year period. Technical details and clinical results are reported.

Methods Retrospective study of open and laparoscopic inguinal hernia repair performed in dept. of pediatric surgery, NSCB Medical College, Jabalpur, M.P. during July 2009 to July 2012 was done.  The variables evaluated were age, sex, type of inguinal hernia, presence of an associated hydrocele, side of hernia, incarceration, obstruction, strangulation, occurrence of opposite-side hernia, recurrence, and other associated complications and conditions. Correlation between radiology and intraopearative findings was done. A total of 540 open internal rings were closed surgically in 490 children (boys and girls, aged 02 days to 14 years, mean 32 months). 400 cases underwent open repair by standard technique and 90 cases underwent laparoscopic surgery. In laparoscopic technique one 5-mm and two 3-mm instruments were used to access the peritoneal cavity. The internal inguinal ring was closed with a non-absorbable suture or tacker as described in paper.

Results There were no significant intraoperative complications. Length of procedure ranged between 20 and 50 minutes with a mean of 35 minutes in laparoscopy and 20 min in open surgery. Postoperative hospital stay ranged from 1 to 3 days. Five children who presented with a right-sided hernia and three with a left hernia (total of 8) were found to have a patent contralateral internal ring on laparoscopy. Mean follow-up was 20 months. There were 2 hernia recurrences (0.4%) 1 in open and 1 in laparoscopic group.

Conclusions Ultrasonography of inguinal region is good adjuvant for diagnosis in doubtful cases. Majority of hernia cases were operated by standard open surgical technique. Laparoscopic hernia repair in children is a safe and feasible technique. There is clear visualization of structures and vas remains untouched and opposite patent ring is seen which can be managed in same setting. As per our experience the recurrence rate is comparable to that of the traditional open approach with a superior cosmetic result.