Laparoscopic treatment of inguinal hernia in the first year of life.

BACKGROUND: Laparoscopic inguinal hernia repair is rarely reported in the first year of life. In this article, we report our experience to emphasize the advantages of this procedure in this age range.

PATIENTS AND METHODS: In a 2-year period, we operated on 315 patients for unilateral inguinal hernia by using laparoscopy. Fifty of 315 patients (15.9%) had less than 1 year of age. This study focused on this group of 50 children (36 boys and 14 girls). The age range was 1-12 months (median, 6.7) with a median body weight of 5.5 kg (range, 3.7-9). As for a technical point of view, we used modified laparoscopic herniorraphy, according to the Montupet technique. After sectioning the sac distally to the ring, the periorifical peritoneum was closed by using a purse-string suture of a nonresorbable suture.

RESULTS: The median operating time was 22 minutes (range, unilateral, 7-30; bilateral, 12-42). All the procedures were performed in a day hospital setting. As for laparoscopic findings in 22 of 50 patients (44%), we found a contralateral patency of the processus vaginalis. In these 22 cases, we performed a bilateral herniorraphy. In 1 girl (2%), we found a coexistence of indirect hernia and a direct hernia on the right side. Both orifices were sutured in laparoscopy. We recorded only 1 minor complication (2%); a problem with needle extraction. With a minimum follow-up of 1 year, we have had only 1 recurrence (1.3%) on 73 herniorraphies performed.

CONCLUSIONS: We believe that laparoscopic repair of inguinal hernia in boys under 1 year of age by expert hands is a safe, effective procedure to perform. Its ability to simultaneously repair all forms of inguinal hernias, together with contralateral patencies, has cemented its role as a viable alternative to conventional repair.