Laparoscopic Inguinal Herniorrhaphy in Premature Infants

Abstract

Introduction: We report the clinical, operative, and outcome results in 58 premature infants (with maximum weight of 5 000 g at time of surgery) undergoing laparoscopic herniorrhaphy.

Patients and Methods: This study was designed as a prospective, non-randomized single center feasibility study. The inclusion criteria were: symptomatic inguinal hernia, gestational age up to 37 weeks and maximum weight of 5 000 g at the time of surgery. Out of 58 premature infants (42 boys and 16 girls), 24 had bilateral, 20 had right-sided and 14 had left-sided hernias. 14 (24.1%) infants were operated on for an irreducible hernia.

Results: The median gestational age at birth was 33 weeks (range 23–37) and the median gestational age at operation was 41 weeks (range 33–52). The body weight at surgery ranged from 1 450 g to 5 000 g (median 3 900 g); 11 infants (19%) weighed less than 2 500 g. No intraoperative surgical complications occurred. Anesthesia complications were noted in 7 cases. At median follow-up of 25 months (range 6–51 months), there were 3 hernia recurrences in 2 infants (3.6%). In 5 boys, we observed high testes requiring subsequent orchiopexy. Regression analysis showed that the risk of undescended testes increased by 65.5% for every 1 kilo lower weight at surgery.

Conclusion: Based on our early results, it seems that laparoscopic hernia repair in preterm infants and very low birth weight babies is a safe and feasible procedure and has some procedural benefits compared to the standard open technique.

Key words

hernia - preterm - laparoscopy

References

• 1 Nagraj S, Sinha S, Grant H. et al . The incidence of complications following primary inguinal herniotomy in babies weighing 5 kg or less.  Pediatr Surg Int. 2006;  22 500-502
• 2 Murphy JJ, Swanson T, Ansermino M. et al . The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit?.  Journal of Pediatric Surgery. 2007;  43 865-868
• 3 Chan KL, Chan HY, Hang Tam PK. Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients of all ages.  Journal of Pediatric Surgery. 2007;  42 1993-1997
• 4 Vogels H, Bruijnen C, Beasley S. Predictors of recurrence after inguinal herniotomy in boys.  Pediatr Surg Int. 2009;  25 (3) 235-238
• 5 Sneider EB, Jones S, Danielson PD. Refinements in selection criteria for pediatric laparoscopic inguinal hernia repair.  Journal of Laparoendoscopic & Advanced Surgical Techniques. 2009;  19 (2) 237-240
• 6 Schorer C. Caudal anesthesia for inguinal herniorrhaphy in preterm infants.  Anasthesiol Intensivmed Notfallmed Schmerzther. 2006;  41 (3) 165-167 [Review]
• 7 Gerber AC, Weiss M. Awake spinal or caudal anaesthesia in preterms for herniotomies: what is the evidence based benefit compared with general anaesthesia?.  Curr Opin Anaesthesiol. 2003;  16 (3) 315-320
• 8 Kim GS, Song JG, Gwak MS. et al . Postoperative outcome in formerly premature infants undergoing herniorrhaphy: comparison of spinal and general anesthesia.  J Korean Med Sci. 2003;  18 (5) 691-695
• 9 Craven PD, Badawi N, Henderson-Smart DJ. et al . Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy.  Cochrane Database Syst Rev. 2003;  CD003669
• 10 Misra D. Inguinal hernias in premature babies: wait or operate?.  Acta Paediatr. 2001;  90 (4) 370-371
• 11 Kumar VH, Clive J, Rosenkrantz TS. et al . Inguinal hernia in preterm infants (≤32-week gestation).  Pediatr Surg Int. 2002;  18 (2–3) 147-152
• 12 Chan KL. Laparoscopic repair of recurrent childhood inguinal hernias after open herniotomy.  Hernia. 2007;  11 (1) 37-40
• 13 Schier F. The laparoscopic spectrum of inguinal hernias and their recurrences.  Pediatr Surg Int. 2007;  23 (12) 1209-1213
• 14 Miyano G, Yamataka A, Okada Y. et al . Sigmoidocolocystoplasty for augmentation of iatrogenic small capacity bladder caused by direct injury to the bladder during inguinal hernia repair: long-term follow-up.  Pediatr Surg Int. 2007;  20 (1) 61-64
• 15 Chung HM, Yu TJ. Bladder rupture after inguinal herniotomy.  Pediatr Surg Int. 1999;  15 (8) 584-585
• 16 Vibits H, Pahle E. Recurrences after inguinal herniotomy in children. Long time follow-up.  Ann Chir Gynecol. 1992;  81 300-302

Correspondence