By Crina Frincu-Mallos, PhD
WASHINGTON, DC -- October 27, 2009 -- Laparoscopic inguinal hernia inversion and ligation (LIHIL) is a safe and effective operation in girls, researchers reported here at the 2009 American Academy of Pediatrics (AAP) National Conference & Exhibition.
Repairing an inguinal hernia through LIHIL involves first inverting the hernia sac into the peritoneal cavity, followed by subsequent ligation. The operation consists in inserting a 5-mm laparoscope through the umbilicus; in addition, 2 stab wounds made in the flanks allow for direct insertion of 2.7-mm laparoscopes.
Using the same incisions, the physicians can diagnose and repair the contralateral side. The procedure also allows for diagnosis of testicular feminisation and other dysgenic conditions, improved cosmesis being one of the benefits, said Aaron M. Lipskar, MD, Pediatric Surgery, Schneider Children's Hospital, North Shore-Long Island Jewish Health System, New Hyde Park, New York.
Dr. Lipskar reported the data here October 17, on behalf of colleagues at North Shore-Long Island Jewish Health System and collaborators from Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Since 2003, five surgeons at the Schneider's Children's Hospital have been performing LIHILs in girls, said Dr. Lipskar. Unfortunately, male hernias cannot be repaired using the LIHIL technique, as the patient would risk the entrapment of the spermatic cord structures. This is a retrospective analysis of all inguinal hernias, both open (n = 91) and LIHIL (n = 173).
The girls operated using LIHIL were aged on average 57 months (range, 1-210 months). The vast majority of these paediatric patients were initially diagnosed with unilateral hernias (n = 156), and a few were diagnosed with bilateral hernias (n = 15). Two of the girls on study were found to have inguinal hernias while actually undergoing other laparoscopic procedures; their hernias were repaired at the time of the original procedure. However, in the course of the LIHIL operation, 34% of the 156 girls diagnosed with clinical unilateral inguinal hernias were found to have bilateral hernias, remarked Dr. Lipskar.
Of 13 girls found to have incarcerated ovaries, 3 required conversion to an open repair. Furthermore, dissection of the fallopian tube from the hernia sac was performed at the time of the ligation in 17/156 girls.
In this cohort, the average operating time was 37 +- 14 minutes.
One of the benefits of this method is the fact that the 5-mm scar is buried in the umbilicus, while the two 3-mm stab wounds heal without a visible scar, according to the investigators.
Furthermore, none of these operations had serious complications and the blood loss was kept to a minimum (<5 mL) due to the nature of the incisions. Also, data collected post operatively indicate that no wound complications occurred in the girls who underwent LIHIL. The investigators were faced with only 2 cases of recurrence in this cohort, both recurrences being repaired using an open technique.
The investigators noted that the operation should be relatively easy to master by most paediatric surgeons possessing basic laparoscopic skills.
[Presentation Title: Laparoscopic Inguinal Hernia Inversion and Ligation in Female Children: A Review of 173 Consecutive Cases at a Single Institution. Abstract 8391]
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