Single-port laparoscopic extraperitoneal repair of pediatric inguinal hernias and hydroceles by using modified Kirschner pin: a novel technique

Background

The development of laparoscopic processus vaginalis repair has provided an alternative approach to the management of inguinal hernia and hydroceles in children. Here we describe our new technique for laparoscopic extraperitoneal ligation of processus vaginalis with subumbilical single-port using a modified Kirschner pin.

Methods

A 5-mm trocar for an operative laparoscope was placed through an infraumbilical incision. A Kirschner pin with a hole in one flat terminal was inserted at the point of the internal inguinal ring. The processus vaginalis was closed extracorporeally by a non-absorbable suture, which was introduced into the abdomen through the Kirschner pin performing dissection within the extraperitoneal space in a series of movements. When a contralateral patent processus vaginalis is present, laparoscopic-assisted extracorporeal ligation is performed during the same operation.

Results

Between September 2010 and September 2012, 211 children (130 cases of inguinal hernia and 81 cases of hydrocele) underwent processus vaginalis repair using this novel technique. A contralateral patent processus vaginalis was present and thus simultaneously closed in 20 patients with unilateral inguinal hernias and 12 patients with unilateral hydroceles. The mean operative time was 18 min (8–35 min). The mean follow-up period is 12 months (range 5–24 months), and no recurrence and complications has been observed to date.

Conclusions

This article describes a unique technique of extracorporeal circuit ligation of processus vaginalis using a minimally invasive technique as afforded by a reused modified Kirschner pin. Single-port laparoscopic processus vaginalis repair using this instrument is feasible and seems to be safe.     

Risk of hernia occurrence where division of an indirect inguinal sac without ligation is undertaken

Abstract We sought to ascertain the risk of inguinal hernia occurrence when division of the processus vaginalis is undertaken without ligation, in the context of laparoscopic Fowler-Stephens orchidopexy. A cohort of patients with intra-abdominal testes subjected to a two-stage Fowler-Stephens procedure was reviewed. Analysis of a 68-month period between November 2005 and August 2011 was performed. A comprehensive search of the literature was undertaken, and these data were compared with previously published studies of patients undergoing orchidopexy or herniotomy where the peritoneal defect was not closed. The procedure was undertaken as previously described, with a conventional first stage using a three-port technique. No attempt was made to approximate the peritoneal margins of the processus vaginalis/hernia or close the internal ring at the second stage. In our own experience 17 patients with undescended testes (2 with bilateral cases) underwent laparoscopically assisted, gubernaculum-sparing, Fowler-Stephens orchidopexy. Median age at first operation was 1.86 years (range, 1-9 years). All 17 patients had successful surgery with all 19 testes palpable within the scrotum at postoperative assessment at 3 and 6 months. No direct, indirect, or incisional hernias were noted at a mean follow-up of 2.7 years (standard deviation 1.71). Our experience and reports in the literature do support simple division of the indirect hernia sac as a tenable alternative to ligation. The result of this limited review would support a prospective randomized trial comparing ligation with simple division of hernia sacs.     

Association of Epididymal Anomalies with Patent Processus Vaginalis in Hernia, Hydrocele and Cryptorchidism

Purpose

We performed a prospective study to assess the relationship between epididymal anomalies and patency of the processus vaginalis in boys presenting with hernia, hydrocele or cryptorchidism.

Materials and Methods

The degree of patency of the processus vaginalis (closed, partially closed or open) and morphology of the ipsilateral epididymis were recorded in 159 consecutive inguinal explorations.

Results

A closed, partially closed and open processus vaginalis was associated with an abnormal epididymis in 14, 36 and 69 percent of cases, respectively. Epididymal anomalies were more frequent in association with undescended (72 percent) than descended (34 percent) testes.

Conclusions

These data confirm the observation of a higher incidence of epididymal anomalies associated with patency of the processus vaginalis irrespective of testicular position, and they support the theory that androgenic stimulation may be required for closure of the processus vaginalis as well as epididymal development.     

Single-port laparoscopic percutaneous double ligation for pediatric inguinal hernias: report of a new technique and early results

Purpose

Several single-port laparoscopic hernial repair methods have been designed to treat inguinal hernia in children, but reliable and safe ligation of the hernial sac should be further investigated. This study aimed to investigate a new technique for laparoscopic percutaneous double ligation for pediatric inguinal hernias with a set of home-made instruments.

Methods

Before each operation, a set of home-made instruments were prepared, including a curved puncture needle, a lasso suture, a dual ligation suture, and occasionally, a flat-headed puncture needle for obese patients. After a series of operational steps, the hernial sac was doubly extracorporeally ligated, leaving only one puncture point in the inguinal region and one incision in the navel.

Results

Between October 2011 and September 2013, 236 children (211 boys and 25 girls) underwent hernial repair using this novel technique. In 38.8 % (85/219) of patients with the preoperative diagnosis of unilateral inguinal hernia, contralateral patent processus vaginalis was confirmed during the laparoscopic surgery and subsequent repair was performed. In 134 cases of unilateral repair, the mean operative time was 11 min (range 5–16 min), and it was 19 min (range 13–29 min) in 102 cases of bilateral repair. No recurrence or complications have been observed to date.

Conclusions

This study shows a unique technique of percutaneous double ligation of the hernial sac using a minimally invasive technique with the aid of a transabdominal 5-mm telescope and a set of home-made instruments. Single-port laparoscopic hernial repair using this technique is feasible and appears to be safe.

     

Factors Affecting the Development of the Processus Vaginalis in the Rat

Purpose

We examined the factors that influence development of the processus vaginalis in the rat.

Materials and Methods

Neonatal Sprague-Dawley rats 0 to 3 days old underwent distal or proximal gubernaculotomy, unilateral orchiectomy or proximal genitofemoral nerve transection. At ages 28 to 60 days the rats were sacrificed, position of the testis was noted and length of the processus vaginalis measured.

Results

There was no development of the processus vaginalis after distal gubernaculotomy. Proximal gubernaculotomy enabled the processus vaginalis to achieve a mean length similar to that of controls (p = 0.06) when the testis descended into the scrotum. Mean length of the processus after proximal gubernaculotomy with an abdominal testis, surgical orchiectomy and torsion of the testis after proximal gubernaculotomy was similar (p = 0.9) but less than that of controls (p less than 0.05). Proximal division of the genitofemoral nerve produced variable results depending on how and when the surgical procedure was performed, and whether the psoas muscle was divided.

Conclusions

Distal attachment of the gubernaculum is essential for normal development of the processus vaginalis. Distal gubernaculotomy prevents development of the processus vaginalis because of mechanical disruption of the gubernaculum. Proximal attachment is not essential for normal development of the processus vaginalis but it serves to anchor the testis to the region of the internal inguinal ring, allowing intra-abdominal pressure to facilitate descent of the testis. In the presence of an innervated gubernaculum the processus vaginalis achieves greater length when the testis descends into the scrotum, suggesting that its complete development demands the presence of a testis in the sac. The timing of genitofemoral nerve division may be crucial in determining the subsequent effect on the development of the processus vaginalis and testicular descent, since programming of the gubernaculum by calcitonin gene-related peptide released from the genitofemoral nerve appears to occur just before birth in the rat.     

Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country

Purpose

We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources.

Methods

Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed.

Results

We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months.

Conclusions

Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.     

Effects of Intraperitoneal Chemotherapy with Mitomycin C on the Prevention of Peritoneal Recurrence in Colorectal Cancer Patients with Positive Peritoneal Lavage Cytology Findings

Background

The detection of intraperitoneal free cancer cells in colorectal cancer (CRC) patients is associated with a poorer prognosis. The aim of this study was to investigate the effects of intraperitoneal chemotherapy (IPC) with mitomycin C (MMC) on preventing peritoneal recurrence in CRC patients with positive peritoneal lavage cytology findings.

Methods

A total of 52 CRC patients who had no clinically confirmed peritoneal dissemination and whose status of peritoneal lavage cytology was positive were investigated. Conventional peritoneal lavage cytology was performed. Overall, 31 of the 52 patients (59.6%) were administered IPC with MMC. Before closure of the abdomen, 4 silicon catheters were inserted into peritoneal cavity. After closure, the perfusate (diluting 20 mg MMC with 500 ml saline) was instilled from the catheter, and all catheters were clumped. All catheters were opened 1 h later.

Results

The mean follow-up period was 83.1 months. According to univariate analyses of all 52 patients and the subgroup of 36 patients with stage II or III tumors, patients with IPC had a significantly better peritoneal recurrence-free survival and cancer-specific survival than patients who did not receive IPC (P < 0.005). In multivariate analysis, IPC remained an independent prognostic factor for peritoneal recurrence-free survival in all patients.

Conclusions

It appears that IPC with MMC is an effective treatment to prevent peritoneal recurrence and prolong the cancer-specific survival in CRC patients without peritoneal dissemination, but who have positive peritoneal lavage cytology. It is necessary to verify the effectiveness of IPC with MMC in a prospective trial.     

Long-term outcomes of emergency Lichtenstein hernioplasty for incarcerated inguinal hernia

Purpose

To evaluate the long-term outcomes of emergency Lichtenstein hernioplasty for incarcerated inguinal hernia.

Methods

The subjects of this prospective, observational study were 24 patients who underwent emergency Lichtenstein hernioplasty for an incarcerated inguinal hernia between September 2002 and January 2006 at the Faculty of Medicine Siriraj Hospital, Thailand. Patients with bowel strangulation and recurrent hernia were excluded. We evaluated the long-term outcomes over at least a 2-year follow-up.

Results

Long-term follow-up was completed for 20 patients (83.3 %). All of the patients were men, with a median age of 60 years (range 19–78 years) at the time of surgery. The median time to resumption of normal daily activities was 3 weeks (range 1–8 weeks). None of the patients had inguinal paresthesia persisting beyond 1 month after the operation. One patient (5 %) experienced chronic groin pain, which subsided within 4 months after surgery. Clinical recurrence was detected in two patients (10 %) during a median follow-up period of 6 years (range 2.3–7.6 years). Contralateral inguinal hernia was found in two patients (10 %) during follow-up.

Conclusions

Lichtenstein hernioplasty is a safe and effective operation for non-strangulated incarcerated inguinal hernia, with a recurrence rate of 10 % at the median follow-up time of 6 years. Chronic groin pain and inguinal paresthesia were rare in this series.     

Surgical findings in acquired undescended testis

Background/purpose

The aim of this study was to retrospectively review the findings at orchidopexy in acquired undescended testis (UDT).

Methods

The authors reviewed a 14-year (1986 through 1999) surgical experience in 360 boys in whom 461 orchidopexies were performed for acquired-UDT. The operative notes were reviewed to determine at operation testis position and volume, persistence of patent processus vaginalis (PV), and attachment of the gubernaculum. Also, testis position after orchidopexy was evaluated.

Results

Age at operation ranged from 2 to 19 years (mean, 8.9 years), 205 of the 461 orchidopexies (44.5%) had been performed between 9 and 12 years of age. In 327 of the 461 cases (70.9%), testis position was documented as intraoperative; in 281 of these cases (86.0%), the testis was located in the superficial inguinal pouch (SIP). A note was made regarding the presence or absence of a hernial sac in 207 of the cases: 113 (54.6%) were associated with an open PV, which usually was slightly open. In 122 of the 461 cases (26.5%), the gubernacular attachment was assessed; in 121 of these (99.2%), a normal attachment of the gubernaculum was noted. At the end of orchidopexy, in 438 of the 461 cases (95.0%), testis position was recorded. Three hundred eighty-two of these testes (87.2%) were at the bottom of the scrotum.

Conclusions

Acquired UDT usually is characterized by SIP position, closed or (small) open PV, and normal gubernaculum attachment. The results of surgery seem excellent.     

Modified single-port laparoscopic herniorrhaphy for pediatric inguinal hernias: based on 1,107 cases in China

Background

Laparoscopic surgery is an alternative procedure for pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We report our experience with the modified single-port laparoscopic herniorrhaphy for repair of PIH and retrospectively evaluate a consecutive series of 1,107 cases in our institution.

Methods

Between February 2006 and July 2011, 1,107 children with indirect inguinal hernia were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-port laparoscopic technique, mainly performed by extracorporeal suturing with an ordinary taper needle (1/2 Arc 11?×?34). The clinical data were retrospectively analyzed.

Results

All surgery was successful without any serious complications. During the operations, contralateral patent processus vaginalis was found and subsequently repaired in 221 cases (20.0?%). The mean operative time was 11 (range 5?C14) min in 815 cases of unilateral repair and 20 (range 14?C27) min in 292 cases of bilateral repair. The mean of postoperative hospital stay was 48 (range 26?C52)?h. Complications occurred in seven cases (0.63?%) and were properly managed, with no major impact on outcome of the operations. There were six recurrent cases (0.54?%) in the patients who had been followed-up for 9?C74?months. There was no obvious scaring visible in any patients after treatment.

Conclusions

The modified single-port laparoscopic technique for the repair of PIH is a safe and reliable procedure with minimal invasion and satisfactory outcome. It is easy to perfect and to perform and therefore is a worthy choice for PIH.     

Hernias complicating chronic ambulatory peritoneal dialysis in children

The sustained hydraulic pressure developed within the peritoneal cavity during chronic ambulatory peritoneal dialysis (CAPD) may develop any actual or potential defect in the inguinal or umbilical area into a clinical hernia. Seven of 19 children have developed inguinal hernias after initiation of CAPD. Demonstration of the presence of a processus vaginalis by peritoneography during catheter placement permits their repair at that time. Late development of clinical indirect inguinal hernias early in our experience after high ligation of the processus vaginalis emphasizes the fact that tight closure of the internal ring is necessary.     

Open inguinal hernia repair with the use of polyglycolic acid/trimethylene carbonate absorbable mesh: a critical update of the long-term results

Purpose

Our group evaluated on a pilot basis open inguinal hernia repair with the use of a fully absorbable mesh aiming to take mesh inguinal hernia repair one step forward. The purpose of the present study was to assess the long-term results of the proposed technique.

Methods

Patients that were included in our previous report were followed up at 3 years after the initial operation.

Results

Ten patients underwent open inguinal hernia repair with the use of an absorbable polyglycolic acid/trimethylene carbonate mesh. 3 years after the procedure, from the total of ten patients, two were lost to follow-up (20 %). Three patients (37.5 %), one with direct and two with indirect hernia, were diagnosed clinically with a recurrence at the follow-up of 3 years. Recurrences were developed nearly 2 years—median 24 months (range 18–30)—after the initial operation. Among patients without recurrence none complained about chronic pain, foreign body sensation or numbness. On the other hand, chronic pain was a constant complain in the recurrence patient group.

Conclusions

The results of the 3-year follow-up in the given patient sample alleviate the initial enthusiasm regarding the use of an absorbable mesh for inguinal hernia repair as an attractive alternative and causes skepticism about the generalized use of the procedure in its certain form.     

Lichtenstein repair of indirect inguinal hernias with acellular tissue matrix grafts in adolescent patients: a prospective,randomized, controlled trial

Purpose

To evaluate the outcomes of Lichtenstein hernioplasty using acellular tissue matrix (ACTM) grafts in adolescent patients.

Methods

One hundred patients, 13–18 years old, with primary unilateral indirect inguinal hernias, were randomly assigned to receive Lichtenstein hernioplasty using ACTM or traditional high ligation of the hernia sac (control group).The outcome measures were the length of the operation, postoperative visual analogue scale (VAS) pain score, length of hospitalization, postoperative complications and recurrence rate.

Results

The length of hospitalization and VAS score were not different between the groups, and the minimum follow-up was 30 months. No postoperative wound infections, chronic postoperative pain or local foreign body sensation occurred in either group. Six patients (14.3 %) in the experimental group and five (11.6 %) in the control group developed scrotal hydroceles (P > 0.05); all resolved with conservative management. There were no recurrences in the experimental group, while there were three (6 %) in the control group (P > 0.05) and all occurred in patients with Gilbert type 3 hernias.

Conclusions

Lichtenstein hernioplasty using ACTM grafts has comparable safety and efficacy to traditional high ligation of the indirect hernia sac in adolescent patients. ACTM can reduce the incidence of recurrence in adolescents with Gilbert type 3 hernias.     

Suction test to demonstrate the peritoneal edge during laparoscopic extraperitoneal inguinal hernia repair

Introduction

Inadequate peritoneal dissection from retroperitoneal structures may account for a large number of hernia recurrences amongst surgeons and trainees who are new to totally extraperitoneal (TEP) laparoscopic inguinal hernia repair. In this paper, we describe a simple dynamic test that allows surgeons to better appreciate the peritoneal edge during the initial dissection phase of TEP inguinal hernia repair, allowing for more adequate dissection of the peritoneum from retroperitoneal structures before placement of mesh.

Methods

Data from a single surgeon was collected on 113 consecutive patients who underwent laparoscopic TEP inguinal hernia repair at the Royal North Shore Hospital in Sydney. The data was retrospectively reviewed to determine the number of cases in which the suction test led to further peritoneal dissection prior to mesh placement.

Operative Technique

After balloon dissection of the pre-peritoneal space and initial dissection of peritoneum and sac from retroperitoneal structures, a laparoscopic suction device is used to aspirate the insufflated gas from the pre-peritoneal space to cause the peritoneum to bulge anteriorly, thus demonstrating the edge of the peritoneal reflection. Further dissection is performed if deemed necessary at this point, and the mesh is placed over the hernia defect.

Results

136 TEP hernia repairs were performed in 113 patients. In 26 (23 %) of patients, the abovementioned technique was of particular value resulting in further dissection of peritoneum prior to mesh placement. There were no complications as a direct result of the test.

Conclusion

This dynamic suction test is a risk-free and useful operative tool for surgeons and trainees who are new to TEP inguinal hernia repair, and provides a definitive way of identifying the peritoneal reflection to ensure the peritoneum has been dissected adequately prior to mesh placement.     

Incidence of contralateral patent processus vaginalis in relation to age at laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia

Introduction

Laparoscopic percutaneous extraperitoneal closure (LPEC) allows the surgeon to look for contralateral patent processus vaginalis (CPPV) directly. We investigated the incidence of CPPV in relation to age at LPEC.

Methods

Following Institutional Review Board approval, 1232 patients ranging in age from 2 months old to 15 years old (median 4.7 years), who underwent LPEC, were investigated retrospectively. Patients were divided into five groups based on their age at surgery: younger than 1, 1–2, 2–4, 4–6 years, and older than 6 years. The incidence of CPPV being detected by preoperative ultrasonography or laparoscopy was compared among these groups. Statistical analyses were performed using the Chi-square test or Cochran–Armitage trend test, and p < 0.05 was considered significant.

Results

The incidence of CPPV detected by ultrasonography decreased as the age increased (p < 0.0001), whereas the incidence of CPPV newly revealed by laparoscopy increased as age increased (p = 0.0001). There were no significant differences in the incidence of CPPV in patients with unilateral hernia among the five age groups (p = 0.74).

Conclusions

These results showed that the incidence of CPPV in patients with unilateral inguinal hernia did not change in relation to their age.

     

Minilaparoscopic herniorrhaphy in pediatric inguinal hernia: a durable alternative treatment tostandard herniotomy

Background

The purpose of the article is to report our long-term results of minilaparoscopic inguinal hernia repair in children.

Methods

Between September 2003 and September 2008, 161 children with inguinal hernia were treated with minilaparoscopic herniorrhaphy. The asymptomatic contralateral internal ring was routinely explored and repaired if a patent processus vaginalis of not less than 2 cm was noted. Patients who were followed for less than 1 year and those who were lost to follow-up were excluded from the study. Intraoperative and postoperative complications and hernia recurrences were documented.

Results

In total, 146 patients were eligible for final analysis. A total of 196 minilaparoscopic herniorrhaphies were performed. The mean follow-up period was 3 years. There were 4 hernia recurrences (2%) in 3 boys. There were no procedure-related complications. None of the patients with a negative contralateral exploration or a contralateral patent processus vaginalis of less than 2 cm had a contralateral metachronous inguinal hernia.

Conclusions

Our long-term results reveal that minilaparoscopic herniorrhaphy combined with hernia sac transection is a safe and effective alternative treatment to standard open herniotomy.     

The role of transforming growth factor beta 1 in communicating and non-communicating hydrocele

Purpose

Repair of inguinal hernia and hydrocele are one of the most common operations performed by surgeons. However, the exact biological mechanism responsible for the closure of processus vaginalis (PV) is not completely understood. Transforming growth factor beta 1 (TGF-β1) is a potent fibrogenic agent and probably stimulate fibrosis and disappearing of PV.

Methods

From September 2012 to December 2014, all boys from 1 to 5 years who were referred for surgery of hydrocele were divided into two groups of communicating (HC) or non-communicating hydrocele (HNC). During surgery, the fluid in the sac was aspirated and sent for biochemical evaluation including calcium, phosphorus, total protein, and TGF-β1. Finally, a biopsy of the sac was sent to the pathology. The results obtained were considered statistically significant (P < 0.05).

Results

The patients were categorized into two groups of non-communicating hydrocele, including 43 patients and communicating, including 33. The patients studied were aged 1–5 years (mean 33.6 months). Biochemical tests on hydrocele fluid showed no significant difference in the levels of calcium, phosphorus, total protein, and bilirubin between two groups. However, mean TGF-β1 in NHC was found to be 53.45–114.28 pg/ml in HC group. A statistically significant difference (P = 0.04) was obtained. Furthermore, the study showed higher amounts of muscles in NHC (P < 0.001).

Conclusion

The amount of TGF-β1 was higher in HC fluid than in non-communicating. To investigate the role of cytokine in the closure of PV, further studies will be required.

     

Comparison of laparoscopic hernia repair and open herniotomy in children: a retrospective cohort study

Background

Laparoscopic hernia repair in infancy and childhood is still debatable. The objective of this study is to compare laparoscopic-assisted hernia repair (LH) versus open herniotomy (OH) as regards operative time, postoperative complications, recurrence rate, and contralateral metachronous hernia rate.

Methods

We analyzed all the patients with inguinal hernia who underwent surgery in our hospital from January 1, 2015 to December 31, 2015. There were 1125 patients, of which 202 patients received laparoscopic inguinal hernia repair (group A) and 923 patients received open herniotomy (group B). We recalled all the patients’ records to identify operative time, postoperative hydrocele formation, and contralateral patent processus vaginalis (CPP) detection; we recalled all the patients’ parents to identify the ipsilateral and contralateral recurrence and the testis position.

Results

During the study period, the lost to follow-up rate is 9.9% in group A and 14.1% in group B. The mean follow-up period was about 10.1 months. The mean operative time for females with bilateral hernia in group A was much shorter than that for those in group B (P = 0.001). The postoperative hydrocele formation rate in group A was 1.5%, compared with 8.2% in group B (P = 0.001). The recurrence rate was 0.64% in group A, whereas in group B the recurrence rate was 0.46%. Of patients with unilateral hernia, none in group A experienced a contralateral metachronous hernia (MH) compared with 10.1% in group B (P < 0.001) and 65% MH appeared in 3 months after the first hernia repair. Females and patients with initial left-sided hernia tended to have a contralateral MH after the first open hernia repair.

Conclusion

Laparoscopic hernia repair in children is safe and effective, especially for female patients and patients with initial left-sided hernia. We recommend repairing the CPP simultaneously when performing laparoscopic procedures.

     

Direct and Recurrent Inguinal Hernias Are Associated with Ventral Hernia Repair: A Database Study

Background

A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery.

Methods

In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral hernia repair.

Results

Direct (Odds Ratio [OR] = 1.28 [95 % CI, 1.08–1.51]) and recurrent (OR = 1.76, [95 % CI, 1.39–2.23]) inguinal hernias were significantly associated with ventral hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic).

Conclusions

Patients with direct and recurrent inguinal herniation are more prone to ventral hernia repair than patients with indirect inguinal herniation. This is the first study to show that herniogenesis is associated with type of inguinal hernia.