Management of Pediatric Inguinal Hernias in the Era of Laparoscopy: Results of an International Survey
15 May 2013
16 July 2013
02 September 2013 (eFirst)
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.
- 1 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 (7) 804-811
- 2 Arul GS, Spicer RD. Where should paediatric surgery be performed?. Arch Dis Child 1998; 79 (1) 65-70 , discussion 70–72
- 3 Borenstein SH, To T, Wajja A, Langer JC. Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair. J Pediatr Surg 2005; 40 (1) 75-80
- 4 Surgical Advisory Panel. American Academy of Pediatrics. Guidelines for referral to pediatric surgical specialists. Pediatrics 2002; 110 (1 Pt 1) 187-191
- 5 Gans SL, Berci G. Advances in endoscopy of infants and children. J Pediatr Surg 1971; 6 (2) 199-233
- 6 Gross RE. Inguinal hernia. In: The Surgery of Infancy and Childhood. Philadelphia, PA: WB Saunders Co.; 1953: 449-462
- 7 Surana R, Puri P. Is contralateral exploration necessary in infants with unilateral inguinal hernia?. J Pediatr Surg 1993; 28 (8) 1026-1027
- 8 Marulaiah M, Atkinson J, Kukkady A, Brown S, Samarakkody U. Is contralateral exploration necessary in preterm infants with unilateral inguinal hernia?. J Pediatr Surg 2006; 41 (12) 2004-2007
- 9 Steven M, Greene O, Nelson A, Brindley N. Contralateral inguinal exploration in premature neonates: is it necessary?. Pediatr Surg Int 2010; 26 (7) 703-706
- 10 Chertin B, De Caluwé D, Gajaharan M, Piaseczna-Piotrowska A, Puri P. Is contralateral exploration necessary in girls with unilateral inguinal hernia?. J Pediatr Surg 2003; 38 (5) 756-757
- 11 Holcomb III GW, Morgan III WM, Brock III JW. Laparoscopic evaluation for contralateral patent processus vaginalis: Part II. J Pediatr Surg 1996; 31 (8) 1170-1173
- 12 Valusek PA, Spilde TL, Ostlie DJ , et al. Laparoscopic evaluation for contralateral patent processus vaginalis in children with unilateral inguinal hernia. J Laparoendosc Adv Surg Tech A 2006; 16 (6) 650-653
- 13 Lee SL, Sydorak RM, Lau ST. Laparoscopic contralateral groin exploration: is it cost effective?. J Pediatr Surg 2010; 45 (4) 793-795
- 14 Wiener ES, Touloukian RJ, Rodgers BM , et al. Hernia survey of the Section on Surgery of the American Academy of Pediatrics. J Pediatr Surg 1996; 31 (8) 1166-1169
- 15 Antonoff MB, Kreykes NS, Saltzman DA, Acton RD. American Academy of Pediatrics Section on Surgery hernia survey revisited. J Pediatr Surg 2005; 40 (6) 1009-1014
- 16 Yang C, Zhang H, Pu J, Mei H, Zheng L, Tong Q. Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis. J Pediatr Surg 2011; 46 (9) 1824-1834
- 17 Shalaby R, Ibrahem R, Shahin M , et al. Laparoscopic Hernia Repair versus Open Herniotomy in Children: A Controlled Randomized Study. Minim Invasive Surg 2012; 2012: 484135
- 18 Nah SA, Giacomello L, Eaton S , et al. Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open?. Eur J Pediatr Surg 2011; 21 (1) 8-11
- 19 Bertozzi M, Melissa B, Magrini E, Bini V, Appignani A. Laparoscopic herniorrhaphy in the pediatric age group: what about the learning curve?. J Endourol 2013; 27 (7) 840-844
- 20 Curry JI. 'See one, practise on a simulator, do one' - the mantra of the modern surgeon. S Afr J Surg 2011; 49 (1) 4-6