Laparoscopic inguinal herniorrhaphy in premature infants

Comparing Outcomes of Single-Incision Laparoscopic Herniorrhaphy in Newborns and Infants

BACKGROUND

As surgical techniques progress, laparoscopic herniorrhaphy is now performed more often in premature babies. The aim of this study was to analyze the outcomes of newborns and infants who underwent single-incision laparoscopic herniorrhaphy (SILH) at our center.

METHODS

We retrospectively reviewed patients younger than 12 months old who received SILH at our department from 2016 to 2020. SILH involved a 5 mm 30-degree scope and 3 mm instruments with a 3-0 Silk purse-string intracorporeal suture for closure of the internal ring. At the time of surgery, Group 1 newborns, whose corrected age was 2 months and below, were compared to the Group 2 infants, whose age was above 2 months. We assessed the patients' characteristics, anesthesia, surgical data, and complications.

RESULTS

A total of 197 patients were included (114 newborns in Group 1 and 83 infants in Group 2). The mean age and body weight in Group 1 were 1.2 months and 3.8 kg, respectively, whereas in Group 2, they were 3.2 months and 6.7 kg, respectively. There were no significant differences in operative time (Group 1 = 34.1 min vs. Group 2 = 32.3 min, p = 0.26), anesthetic time (Group 1 = 80.0 min vs. Group 2 = 76.3 min, p = 0.07), length of hospitalization (Group 1 = 2.3 days vs. Group 2 = 2.4 days, p = 0.88), postoperative complications including omphalitis (Group 1 = 5.3% vs. Group 2 = 1.2%, p = 0.13), wound infection (Group 1 = 0.9% vs. Group 2 = 1.2%, p = 0.81), and hydrocele (Group 1 = 0.35% vs. Group 2 = 8.4%, p = 0.14). No recurrence, testicular ascent or atrophy, or mortality was observed in either group during the 2-year follow-up period.

CONCLUSIONS

Single-incision laparoscopic herniorrhaphy is a safe and effective operation for inguinal hernia repair in infants, even those with prematurity, lower body weight at the time of surgery, or cardiac and/or pulmonary comorbidities. Comparable results revealed no significant differences in perioperative complications despite younger ages and lower body weights.

Comparison of Recurrence and Complication Rates Following Laparoscopic Inguinal Hernia Repair among Preterm versus Full-Term Newborns: A Systematic Review and Meta-Analysis

Background: Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, although it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. Methods: Scientific databases (PubMed, EMBASE, Scopus, and Web of Science databases) were systematically searched for relevant articles. The following terms were used: (laparoscopic hernia repair) AND (preterm). The inclusion criteria were all preterm newborns with a unilateral or bilateral inguinal hernia who underwent LHR. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following LHR. Results: The present meta-analysis included four comparative studies. Three studies had a retrospective study design while one was a prospective study. A total of 1702 children were included (PT n = 523, FT n = 1179). The incidence of hernia recurrence showed no significant difference between the PT versus FT groups (RR = 2.58, 95% CI 0.89–7.47, p = 0.08). A significantly higher incidence of complications was observed in the PT group compared to the FT group (RR = 4.05, 95% CI 2.11–7.77, p < 0.0001). The PT group of newborns accounted for 81% and 72% of the major and minor complications. The major complications were either non-surgical (i.e., severe respiratory distress requiring reintubation with prolonged ventilation (or high-frequency ventilation), seizures, bradycardia), or surgical (i.e., hydroceles requiring operative intervention and umbilical port-site hernia). Conclusions: LHR in PT infants is associated with similar recurrence rates as in FT infants. However, the incidence of complications is significantly higher in PT versus FT infants.

Comparison of laparoscopic percutaneous internal ring suturing method and open inguinal hernia repair in children under 3 months of age

Objective: Laparoscopic inguinal hernia repair in younger infants has not been completely accepted worldwide. The aim of this study was to evaluate the safety and feasiblity of laparoscopic percutaneous internal ring suturing method in children aged younger than 3 months and compare the recurrence and complication rates with open repair; which may still be mentioned as the gold standard procedure.

Material and Methods: A total of 387 children underwent inguinal hernia repair in the clinic between 2016 and 2019. One hundred and forty of them were under 3 months old and divided into two groups; children who underwent laparoscopic percutaneous internal ring suturing (Group 1) and open surgery (Group 2). Selection of the surgical method was regardless of weight, sex or any patient characteristics other than surgeon’s choice. Operation durations, complications and recurrences were compared between the two groups.

Results: A total of 140 patients underwent surgery due to inguinal hernia. Group 1 included 85 and Group 2 included 55 children. There were two recurrences in each group (p> 0.05). Operative durations were shorter in Group 1 for both; unilateral and bilateral repairs (< 0.0001). There were no intraoperative complications in any group. There was one major postoperative complication in Group 2: iatrogenic undescended testis, and none was observed in Group 1. In the laparoscopic group, 47% of the children who were diagnosed to have unilateral hernia were revealed to have bilateral inguinal hernias (n= 31).

Conclusion: Laparoscopic percutaneous internal ring suturing method seems favourable in terms of operative time. It also has the advantage of detecting contralateral patent processus vaginalis or asymptomatic contralateral inguinal hernia.

A single institution experience with Laparoscopic Hernia repair in 791 children

INTRODUCTION

There are many described technique to performing laparoscopic inguinal hernia repair in children. We describe our outcomes using a percutaneous internal ring suturing technique.

METHODS

A retrospective review of patients under 18 years old who underwent repair between January 2014 - March 2019 was performed. A percutaneous internal ring suturing technique, involving hydro-dissection of the peritoneum, percutaneous suture passage, and cauterization of the peritoneum in the sac prior to high ligation, was used. p < 0.05 was considered significant during the analysis.

RESULTS

791 patients were included. The median age at operation was 1.9 years (IQR 0.37, 5.82). The median operative time for a unilateral repair was 21 min (IQR 16, 28), while the median time for a bilateral repair was 30.5 min (IQR 23, 41). In total, 3 patients required conversion to an open procedure (0.4%), 4 (0.6%) experienced post-operative bleeding, 9 (1.2%) developed a wound infection, and iatrogenic ascent of testis occurred in 10 (1.3%) patients. Twenty patients (2.5%) developed a recurrent hernia. All but two 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 recurrence.

Comparative Analysis of Laparoscopic Inguinal Hernia Repair in Neonates and Infants

BACKGROUND

This study analyzed our cohort of infants (age below 12 mo) who underwent laparoscopic inguinal hernia repair (LIHR), comparing those 3 months and below (corrected premature) to above 3 months (term infants) corrected age at the time of surgery.

MATERIALS AND METHODS

Retrospective analysis of a single surgeon and associated trainees' experience of LIHR in infants below 12 months over a 5-year period (2013-2018) was performed. The operative technique involved a 5-mm scope and 3-mm instruments for herniorrhaphy with 4/0 Prolene purse-string suture. Data collected included patient demographics, prematurity (<37 wk), corrected age and weight at surgery, preoperative hemoglobin level, comorbidities, anesthetic time, major perioperative complications, and inguinal hernia recurrence. A comparison was made between those operated at 3 months and below and above 3 months corrected age. Perioperative issues affecting infants 3 months and below were identified and analyzed. Statistical analysis includes T test and Fisher exact test (P<0.05 significance).

RESULTS

Eighty infants underwent LIHR (age below 12 mo), of which 67 (84%) were male with a median corrected age of 10.5 (range 2.5 to 44) weeks, the median weight of 5.5 kg (range 2.1 to 10.8). A total of 47 (59%) infants had a unilateral inguinal hernia repair and 33 (41%) had a bilateral repair. The median anesthetic time was significantly greater for infants 3 months and below at 93 (range 61 to 125) minutes, compared with 83 (range 47 to 146) minutes for the above 3 months age group (P=0.001) There were no perioperative complications or mortality. One patient had a recurrence of an inguinal hernia. Low hemoglobin levels, comorbidities, and extreme prematurity required more attention during preoperative assessment and postoperative management.

CONCLUSIONS

Comparable cohorts demonstrated no significant difference in recurrences despite significant differences in weight and median anesthetic time. Preoperative hemoglobin is an important factor that needs to be addressed in infants 3 months and below for scheduling the procedure date (transfusion vs. iron supplementation).

Risk of incarceration in children with inguinal hernia: a systematic review

BACKGROUND

Surgical repair is recommended for all children with inguinal hernia due to fear of incarceration. The aim of this study was to assess the risk of incarceration and strangulation of inguinal hernias in children treated with delayed surgery or no surgery.

METHODS

Systematic searches were conducted in three databases. We included studies reporting on children with inguinal hernia, with the majority ≤ 10 years old. The interventions were non-acute inguinal hernia surgery or no surgery. The main outcomes were incarceration and strangulation. Secondary outcomes were postoperative complications. Randomized controlled trials, non-randomized controlled trials, and observational studies were included.

RESULTS

We included 22 studies with 14,959 children. All studies reported on elective repairs. None of the studies specifically reported on watchful waiting. Of the studies reporting wait time as mean or median, the median wait time was 46 days (range 1-552). The crude incarceration rate across the included studies was 7% for all children and 11% for preterm children. The testicular atrophy rate was 1% and the recurrence rate was 1%.

CONCLUSIONS

The risk of incarceration in children awaiting inguinal hernia surgery is substantial. In general, we cannot support delaying surgery unnecessarily. However, there may be benefits of delaying surgery in individual cases. In such cases, the surgeon should assess if the benefits may overrule the risk of incarceration.

Comparison of laparoscopic percutaneous extraperitoneal closure versus conventional herniotomy in extremely low birth weight infants

PURPOSE

Laparoscopic percutaneous extraperitoneal closure (LPEC) has become routine for repairing pediatric inguinal hernia (IH). Reports on the effective repair of IH in challenging cases, such as extremely low birth weight infants (ELBWI) who become symptomatic soon after birth and have surgery before 1 year of age, are rare; and conventional herniotomy (CH) in ELBWI requires extensive experience of neonatal surgery. We compared LPEC with CH for treating ELBWI with IH.

METHODS

Consecutive ELBWI with IH treated by either LPEC (n = 17) or CH (n = 22) before 1 year of age between 2012 and 2017 were reviewed. LPEC were performed by consultant pediatric surgeons (CPS; n = 3) with experience of at least 200 cases each. In CH, 11 cases were treated by CPS and 11 by CPS-supervised surgical trainees.

RESULTS

There were no intraoperative complications. Operative time and anesthesia time for bilateral IH repairs were both shorter in LPEC. Postoperative sequelae were recurrence (LPEC; n = 1; repaired by redo LPEC 2 months after the initial repair) and intravenous rehydration (CH; n = 1; for persistent post-anesthetic vomiting). Recovery was unremarkable in all cases without additional analgesia.

CONCLUSION

LPEC would appear to be a viable option for treating IH in ELBWI, especially bilateral cases.

Evidence supporting laparoscopic hernia repair in children

PURPOSE OF REVIEW

Pediatric inguinal hernias are a commonly performed surgical procedure. Currently, they can be approached via open or laparoscopic surgery. We summarize the current evidence for laparoscopic inguinal hernia repairs in children.

RECENT FINDINGS

Laparoscopic and open inguinal hernia repair in children are associated with similar operative times for unilateral hernia, as well as similar cosmesis, complication rates and recurrence rates. Bilateral hernia repair has been shown to be faster through a laparoscopic approach. The laparoscopic approach is associated with decreased pain scores and earlier recovery, although only in the initial postoperative period. Laparoscopy allows for easy evaluation of the patency of contralateral processus vaginalis, although the clinical significance of and need for repair of an identified defect is unclear.

SUMMARY

Laparoscopic surgery for pediatric inguinal hernias offers some advantages over open repair with most outcomes being equal. It should be considered a safe alternative to open repair to children and their caregivers.

Single-center, retrospective study of the outcome of laparoscopic inguinal herniorrhaphy in children

Laparoscopic hernia repairs are used increasingly in children.The purpose of this single-center cohort observational research study was to analyze the outcome of children treated surgically for unilateral or bilateral inguinal hernia using laparoscopy.We did a STROBE-compliant retrospective outcome analysis of pediatric, laparoscopic hernia repair. Consecutive laparoscopic herniorrhaphies in 123 children done between March 2, 2010, and March 1, 2014, were included in this analysis. Data analysis was based on reviewing the hospital records and a prospective questionnaire. We evaluated postoperative hernia recurrence rate, occurrence of postoperative complications, duration of postoperative pain medication, and wound cosmesis.We first performed laparoscopic inguinal herniorrhaphy according to the techniques described by Schier et al and Becmeur et al in March 2010. We treated 46 girls and 77 boys with laparoscopically confirmed inguinal hernias, and their ages ranged from 0 to 16 years. Of these, 77 children suffered from unilateral hernias, 30 from unilateral hernias with contralateral patency of the vaginal process, and 16 from indirect bilateral hernias. The median follow-up interval was 38 months (range: 13-58 months). Overall, 8 (6.5%) of these 123 patients experienced a recurrence of the inguinal hernia. Two patients (1.6%) suffered a postoperative infection. Postoperative pain medication was administered by parents for 1 to 3 days in 67 (63.8%) of the 105 families who answered the question, and no pain medication was administered by 5 (4.0%) parents. Wound cosmesis was rated by the parents as invisible or barely visible in 106 (86.2%) of 123 patients and esthetically disturbing in 4 (3.2%) children.Laparoscopic inguinal hernia repair carries a learning curve and is safe and efficient in children thereafter. Further prospective studies are required to evaluate the long-term outcome of laparoscopic inguinal hernia repair in children.

Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial

PURPOSE

Laparoscopy is being increasingly applied to pediatric inguinal hernia repair. In younger children, however, open repair remains preferred due to concerns related to anesthesia and technical challenges. We sought to assess outcomes after laparoscopic and open inguinal hernia repair in children less than or equal to 3 years.

METHODS

A prospective, single-blind, parallel group randomized controlled trial was conducted at three clinical sites. Children ≤3 years of age with reducible unilateral or bilateral inguinal hernias were randomized to laparoscopic herniorrhaphy (LH) or open herniorrhaphy (OH). The primary outcome was the number of acetaminophen doses. Secondary outcomes included operative time, complications, and parent/caregiver satisfaction scores.

RESULTS

Forty-one patients were randomized to unilateral OH (n = 10), unilateral LH (n = 17), bilateral OH (n = 5) and bilateral LH (n = 9). Acetaminophen doses, LOS, complications, and parent/caregiver scores did not differ among groups. Laparoscopic unilateral hernia repair demonstrated shorter operative time, a consistent finding for overall laparoscopic repair in univariate (p = 0.003) and multivariate (p = 0.010) analysis. No cases of testicular atrophy were documented at 2 (SD = 2.7) years.

CONCLUSION

Children ≤3 years of age in our cohort safely underwent LH with similar pain scores, complications, and recurrence as OH. Parents and caregivers report high satisfaction with both techniques.

Management of inguinal hernia in premature infants: 10-year experience

AIM

Debatable issues in the management of inguinal hernia in premature infants remain unresolved. This study reviews our experience in the management of inguinal hernia in premature infants.

MATERIALS AND METHODS

Retrospective chart review of premature infants with inguinal hernia from 1999 to 2009. Infants were grouped into 2: Group 1 had repair (HR) just before discharge from the neonatal intensive care unit (NICU) and Group 2 after discharge.

RESULTS

Eighty four premature infants were identified. None of 23 infants in Group 1 developed incarcerated hernia while waiting for repair. Of the 61 infants in Group 2, 47 (77%) underwent day surgery repair and 14 were admitted for repair. At repair mean postconceptional age (PCA) in Group1 was 39.5 ± 3.05 weeks. Mean PCA in Group 2 was 66.5 ± 42.73 weeks for day surgery infants and 47.03 ± 8.87 weeks for admitted infants. None of the 84 infants had an episode of postoperative apnea. Five (5.9%) infants presented subsequently with metachronous contralateral hernia and the same number of infants had hernia recurrence.

CONCLUSIONS

Delaying HR in premature infants until ready for discharge from the NICU allows for repair closer to term without increasing the risk of incarceration. Because of low occurrence of metachronous hernia contralateral inguinal exploration is not justified. Day surgery HR can be performed in former premature infant if PCA is >47 weeks without increasing postoperative complications.

Neonatal laparoscopic inguinal hernia repair: a 3-year experience

PURPOSE

To retrospectively analyze the feasibility, safety and complication rate of laparoscopic inguinal herniorraphy in babies weighing 5 kg or less.

METHODS

Thirty infants weighing 5 kg or less underwent laparoscopic inguinal hernia repair during a 3-year period. Twenty-eight infants were born preterm and the mean body weight at surgery was 3,800 kg. Internal inguinal ring was closed with a non-absorbable purse-string suture. Contralateral processus vaginalis was closed if patent. Feeding was started on the same day and the patient discharged the following day. Follow-up consisted of physical examination at 1 week, 6 and 12 months post-operatively.

RESULTS

Of the 30 patients (27 males, 3 females), 11 had bilateral and 19 monolateral hernia (16 right, 3 left). At laparoscopy, 23 infants needed to have bilateral herniorraphies. The mean corrected gestational age at surgery was 49.1 weeks. The mean operative time for repair was 30 min for unilateral and 41 min for bilateral hernia. There were not intra- or post-operative complications as well as conversions or recurrences.

CONCLUSIONS

Laparoscopic inguinal hernia repair in newborns and in ex-preterm infants is a safe and effective procedure to perform and, perhaps, even less technically demanding than open herniotomy.

Long-term outcomes of laparoscopic intracorporeal inguinal hernia ligation in infants under 1 year of age

BACKGROUND

The majority of current literature regarding laparoscopic inguinal hernia repair group all their pediatric patients together. This study aimed to evaluate the long-term outcomes of patients who underwent laparoscopic intracorporeal inguinal hernia ligation under the age of 1 year to ascertain if there were hidden advantages or limitations in this particular group.

PATIENTS AND METHODS

Patients under the age of 1 year at time of laparoscopic intracorporeal inguinal hernia ligation by a single pediatric surgeon were identified. Data were obtained from case notes, hospital electronic records, and parental telephone consultation.

RESULTS

One hundred fourteen patients under the age of 1 year underwent laparoscopic inguinal hernia repair from November 2003 to October 2010. The male:female ratio was 4:1. The mean corrected age at surgery was 15.5 (range, 3-42) weeks, and the mean weight at surgery was 5.3 (range, 1.9-9.8) kg. All patients' case notes and electronic records were accessed. Forty-two percent of parents were contactable (mean of 4 years following surgery). There was one recurrence on the asymptomatic side in a boy that presented 3 years later. Five patients required orchidopexy following laparoscopic hernia repair, although 3 cases were known to be undescended at the time of surgery. One patient had intermittent ipsilateral groin swelling that resolved spontaneously after 6 months.

CONCLUSIONS

Laparoscopic intracorporeal inguinal hernia ligation in patients under the age of 1 year is safe and effective. Recurrence rates may be lower than those in patients under 1 year of age undergoing a traditional open repair. However, there may be a higher rate iatrogenic of cryptorchidism in this laparoscopic group.

Cardiorespiratory complications after laparoscopic hernia repair in term and preterm babies

PURPOSE

The aim of this study was to clarify the incidence of postoperative complications in infants undergoing laparoscopic hernia repair within the first six months of life.

METHODS

Retrospective, single-institution study comparing term and preterm babies undergoing surgery between March 2005 and September 2012. The charts were reviewed for postoperative complications and pre-existing diseases.

RESULTS

In the term group 188 of 199 babies (94.5%) had an uneventful postoperative course. Eleven patients (5.5%) presented postoperative complications, three of them (1.5%) developed severe respiratory complications. A relation between pre-existing diseases and postoperative complications could be identified in two patients. Laparoscopy possibly induced cardiorespiratory instability in one infant. In the preterm group 109 of 137 babies (79.6%) had an uneventful postoperative course. 28 preterm infants (20.4%) developed postoperative complications, seven of them (5.1%) presented severe respiratory complications. Pre-existing diseases were identified as an influencing factor in 22 preterm infants. In one patient laparoscopy possibly caused minor instability of a pre-existing cardiac anomaly.

CONCLUSIONS

Postoperative complications are low in both groups, although the incidence is increased in preterm infants. Pre-existing diseases are a major influencing factor for preterm infants. In very few infants laparoscopy may have induced instability of cardiac anomalies.

Laparoscopic inguinal hernia repair in premature neonates: is it safe?

OBJECTIVE

With advances in clinical medicine, many premature babies nowadays can have excellent survival outcomes. As the incidence of inguinal hernias in this group is high and there is scarce data in the literature regarding the optimal timing for repair, this study aims to review our experience in laparoscopic repair in premature infants.

METHODS

In our centre, premature neonates with inguinal hernia noted during hospitalization were offered laparoscopic repair when the body weights reached 2.5 kg unless there is contraindication for laparoscopy. A retrospective review was carried out for all premature neonates who underwent laparoscopic inguinal hernia repair from 2001 to 2011. The operative results, complications, incarceration risk and postoperative apnea risk were recorded.

RESULT

A total of 79 premature neonates received laparoscopic inguinal hernia repair during this period. The mean gestational age at birth was 31.9 weeks (27-36 weeks) and the mean gestational age at operation was 46.5 weeks (33-92 weeks). One patient had incarceration and required emergency operation while waiting for the elective repair. The mean operative time was 44.9 min (25-93 min). One patient (1.3 %) had recurrence. No postoperative apnea was noted in any patient.

CONCLUSION

Laparoscopic hernia repair is safe and feasible in premature neonates when they attain reasonable body size, as long as there is excellent anaesthesia support. Low risk of incarceration was noted in this study and it is worth waiting for the body weight to build up and hence facilitate laparoscopic repair.

Outcomes following laparoscopic inguinal hernia repair in infants compared with older children

PURPOSE

Indications for laparoscopic inguinal hernia repair in infants and children remain controversial. The purpose of this study is to compare clinical features and outcome of laparoscopic inguinal hernia repair in infants with older children.

METHODS

Retrospective single centre review of all patients <16 years of age (n = 380) undergoing laparoscopic inguinal hernia repair over a 5-year period (Jan 2005-Dec 2009). Outcomes were compared between infants (≤ 12 months of age) with older children (1-15 years).

RESULTS

There was a trend towards higher recurrence rate in older children than in infants (4 % vs. 1 %; p = 0.17). Total complications and complications requiring surgery were similar in both age groups. There was one testicular atrophy in an infant who had an incarcerated inguinal hernia. The incidence of bilateral inguinal hernia and contralateral patent processus vaginalis (PPV) were both significantly higher in infants (total 61 % compared with 35 % in older children).

CONCLUSIONS

Laparoscopic inguinal hernia repair in infants is safe and carries acceptable complication and recurrence rates. The laparoscopic approach may be particularly beneficial in infants since it allows simultaneous closure of a contralateral PPV and bilateral herniae. The outcome of laparoscopic inguinal hernia repair in older children requires further evaluation.

Laparoscopic inguinal hernia repair in premature babies weighing 3 kg or less

PURPOSE

This retrospective study aims to evaluate the feasibility, safety and complication rate of laparoscopic inguinal hernia repair for small babies weighing 3 kg or less.

METHODS

A retrospective analysis was performed on the surgical charts of 67 infants (47 boys and 20 girls) weighing 3 kg or less who underwent laparoscopic hernia repair in a 3-year period. A regular 5-mm scope was used for visualization, and 2 or 3-mm instruments were used for the closure of the inner inguinal ring using 3/0 non-absorbable suture. The median weight at surgery was 2,600 g (range 1,450-3,000 g). All except three were premature.

RESULTS

Of the 67 infants, 15 (22.3 %) presented with an irreducible hernia. In three cases of irreducible hernias, we also performed a transumbilical appendectomy at the end of the hernia repair. Minor problems related with anesthesia were noted in four cases. Hernia recurrence was observed in three patients (4.4 %). No cases of testicular atrophy occurred. In 10 boys, we observed 12 cases of high testes, only 4 testes requiring subsequent orchiopexy.

CONCLUSIONS

Laparoscopic inguinal hernia repair for babies weighing 3 kg or less is feasible, safe and perhaps even less technically demanding than open inguinal herniotomy.

Minimally invasive surgery in the neonate

The advent of minimally invasive surgical techniques in the neonate has been delayed due to the limited working space and the unique physiology of the newborn. In the last decade, with the introduction of new instruments and techniques, many of the initial problems have been solved making minimally invasive surgery feasible for a variety of indications in the neonate and a favored approach in specialized centers around the world. Although an increasing number of reports document the feasibility of this exciting technique, data demonstrating its benefit compared to conventional surgery is limited. This review focuses on recent developments in minimally invasive surgery in neonates and the evidence for its use.

Microlaparoscopic hernia repair in children: initial experiences

INTRODUCTION

This study reports the authors' experience with the exclusive use of 2-mm instrument sets and small diameter scopes in 100 children undergoing microlaparoscopic herniorrhaphy.

METHOD

This prospective study was designed as a pilot feasibility study; all data related to patients and procedures were prospectively collected. A pneumoperitoneum was established, and 1.7 to 2 mm 0° or 30° scopes were introduced for visualization. Exclusively 2-mm instruments were used.

RESULTS

This study included 100 children (aged 15 days to 11 years, median age 2.3 years) undergoing microlaparoscopic hernia repair. A total of 140 hernias were treated. The average operative time for the microlaparoscopically experienced surgeon was 16 minutes for bilateral inguinal hernia and 12 minutes for unilateral hernias. All procedures were completed microlaparoscopically. Hernia recurrence was observed in 2 patients.

CONCLUSION

Based on the authors' early experience, it is found that microlaparoscopic hernia repair in children seems to be a safe and feasible procedure.