A Single Institution Experience with Laparoscopic Hernia Repair in 500 Children

Background: There are many different versions of performing laparoscopic inguinal hernia repair in children. We aim to describe our outcomes in patients who have undergone a laparoscopic hernia repair using a percutaneous internal ring suturing technique. Methods: A retrospective institutional review of patients under 18 years old who underwent a laparoscopic inguinal hernia repair between January 2014 and June 2017 was performed. We used a percutaneous internal ring suturing technique that involves hydro-dissection of the peritoneum, percutaneous suture passage, and cauterization of the peritoneum in the sac prior to high ligation. Demographics, operative characteristics, outcomes and complications were recorded. Analysis was performed using STATA® (StataCorp, College Station, TX). Results: Five hundred patients were included. Eighty three percent were male, and the median age at operation was 1.85 years (IQR 0.40, 5.60). The median operating time for all patients was 25 minutes (IQR 18, 35). Ninety-two patients had concurrent procedures along with their inguinal hernia repair. Looking at those who underwent hernia repair alone, the median operative time for a unilateral repair was 20 minutes (IQR 14, 26), while the median time for a bilateral repair was 28.5 minutes (IQR 21, 40). Two patients required conversion to an open procedure (0.4%), 4 (1%) experienced post-operative bleeding and 6 (1%) developed a wound infection. There was no injury to the vas deferens or testicular vessels. Iatrogenic ascent of testis occurred in only 4 patients post-operatively at a median time of 214 days (IQR 31, 466) after hernia repair. Fourteen patients (3%) developed a recurrent hernia at a median of 328 days (IQR 149, 526) following initial hernia repair. All were re-repaired laparoscopically. Conclusions: The use of percutaneous internal ring suturing for laparoscopic repair of inguinal hernias in the pediatric population is safe and effective with a low rate of complications and recurrences.