(1)
Department of Paediatric Surgery, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK
Abstract
Potential advantages of the laparoscopic approach to inguinal hernias in children include avoiding handling of the vas and vessels in boys, inspection of the internal genital organs in girls, and diagnosis of asymptomatic contralateral hernia. In experienced hands, the recurrence rate is minimal and approaches that of open surgery. It may be an advantageous approach to incarcerated hernias.
Keywords
Laparoscopic hernia repairPaediatricsInguinal herniaPatent processus vaginalis31.1 General Information
Potential advantages of the laparoscopic approach to inguinal hernias in children include avoiding handling of the vas and vessels in boys, inspection of the internal genital organs in girls, and diagnosis of asymptomatic contralateral hernia. In experienced hands, the recurrence rate is minimal and approaches that of open surgery. It may be an advantageous approach to incarcerated hernias.
31.2 Working Instruments
5-mm Hasson port
30° (preferable) or 0° telescope
3-mm needle holders
3-mm scissors
3-mm Maryland forceps
31.3 Positioning, Port Siting, and Ergonomic Considerations
A 5-mm umbilical port is used as the primary port. Other working instruments are placed as shown in Fig. 31.1. In bilateral cases, the two working ports are placed in each of the lumbar regions. A direct puncture of the abdominal wall, without port placement, is used for the working instruments, as there is very little exchange of instruments during the procedure. A needle holder is placed in the dominant hand and a grasper in the opposite. In small infants and neonates, shorter instruments allow more ergonomic movements.
Fig. 31.1
Positioning of ports for left (a) and bilateral (b) inguinal hernia in an infant
31.4 Relevant Anatomy (Fig. 31.2)
Fig. 31.2
(a) Closed right inguinal canal in a boy. The ring is closed, and the cord structures may be seen entering the closed deep inguinal ring. (b) Open left inguinal ring in a boy. The ring is seen here to be widely opened, and it has a horseshoe shape. (c) Inside of an inguinal hernia in a boy. In this instance, the patent processus vaginalis (hernia sac) reaches the scrotal level but stops short of the testis itself. The vas (lower middle) and vessels (from right lateral side) may be seen travelling beyond the hernia sac to the testis. (d) Inside of an inguinal hernia with the testis in the sac. In this instance, the patent hernia sac reaches the testis itself, which may be seen with the laparoscope. (e) Open inguinal canal and right inguinal hernia in a girl. The inguinal ligament is seen clearly from inside the abdomen in this photograph. (f) Reduced ovary. The ovary is shown in this second picture after being reduced from the inguinal canal
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
