32 Laparoscopic Inguinal Hernia Repair; A Review of 5 years of Practice
Aileen Rooney1, Alexander Cho2, Suzann Baumann2, Katherine Burnand2, Simon Blackburn2, Simon Eaton2, Stephano Giuliani2, Clare Rees2, Joe Curry2, Kate Cross2, Paolo De Coppi2
1Great Ormond St, London, United Kingdom. 2Great Ormond Street Hospital, London, United Kingdom

Abstract

Aim

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).

 

Methods

 

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.

 

Results

 

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).

 

Conclusion

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.


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