To review the experience of laparoscopic inguinal hernia repair (LIHR) in our centre to identify safety, complication rates, and the closure of asymptomatic patent processus vaginalis (PPV).
We performed a retrospective review of all LIHR performed between 2009 and 2014. Patient demographics, operation and case notes were reviewed and analysed. Data was analysed using Fisher-Exact test and is quoted as median (range) unless indicated.
525 patients underwent LIHR. 418 (80%) patients were male, 107 were female. 229 (44%) infants were born prematurely (< 36 weeks). Corrected gestational age at surgery was 3months (29/40 to 165 months) and weight was 5.9kg (1-65 kg). A total of 810 inguinal rings were closed; 583 were symptomatic (right 302, left 165, bilateral 58), and 227 asymptomatic PPV were closed. There were 11 hernia recurrences in 9 patients (2%). 3 were in patients who originally had an expedited repair for recent incarceration. The operative surgeon was a consultant in 4 cases, and trainee in 8 cases (p= 0.24). None of the hernia recurrences had a second suture or z-suture placed which was significant (p= 0.002).
10 (2%) testes that had been descended pre operatively required subsequent orchidopexy, and a further patient had testicular atrophy. 2.5% of all asymptomatic PPV’s closed in boys resulted in requirement for orchidopexy (4 orchidopexies). A second suture or Z suture did not increase the rate of testicular ascent. Time to orchidopexy was 30 months (15-84 months).
Risk of hernia recurrence after laparoscopic repair was low, and may be lower if a second suture or z-suture is undertaken. 48.6% of patients who had unilateral symptomatic herniae had closure of an asymptomatic PPV however the complications specifically iatrogenic injury to the testis remains low. Testicular ascent is a late complication and longer follow up periods should be considered.