Technical refinements in laparoscopic repair of childhood inguinal hernias

Background: This study aimed to evaluate the laparoscopic repair of childhood hernias and to identify technical refinements for improvements. Methods: The records of 49 boys and 13 girls who underwent laparoscopic hernia repair in the authors' institution between July 2002 and July 2003 were reviewed. Their mean age was 4.5 years (range, 3 months to 15 years). No hernia opening was found in two patients, whereas 17 bilateral hernias (28%, 17/60) were found laparoscopically. Two bilateral hernias were diagnosed preoperatively. Four patients had the operation for recurrent hernias after open procedures. Results: Over a mean follow-up period of 7.5 months (range, 3-15 months), there was one recurrence (1%, 1/79), but no other complication. With saline injection administered extraperitoneally, laparoscopic hernia repair can be performed safely for boys. Use of the "needle" sign avoided damage to the testicular vessel and vas. Placement of the needle medial to a prominent inferior epigastric artery and the presence of a "complete ring" sign prevented recurrence. The use of reusable 3-mm ports and round polypropylene stitches lowered the cost of the operation and improved the cosmesis for the patients. For recurrent hernias after open repair, the laparoscopic method was as simple as fresh hernia repair. Conclusions: Laparoscopic hernia repair allows detection and repair of contralateral hernias during the same operation. With refinements in technique, the procedure can be safely performed for boys, with the added advantages of lower costs, fewer recurrences, and improved cosmesis.