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RESULTS OF SINGLE-INCISION LAPAROSCOPIC SURGERY THROUGH THE UMBILICUS FOR THE TREATMENT OF INCARCERATED INGUINAL HERNIA IN CHILDREN
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Abstract
Purpose: To present the technique and report our results on the single-incision laparoscopic surgery through the umbilicus (SILS) for the treatment of incarcerated inguinal hernia (IIH) in children. We report our experience on 186 cases. Methods: We retrospectively reviewed the cases of children with IIH who underwent SILS at the Department of Pediatric Surgery, Saint Paul Hospital, Hanoi, from June 2016 to June 2024. All patients were operated on using the SILS method, placing two trocars (one 5mm and one 3mm) through a 10mm skin incision at the umbilicus, and using 3mm bowel grasping forceps to release the incarcerated contents. A 17G epidural needle and a steel wire were used to guide the suture for closing the internal inguinal ring. Results: In a total of 4872 patients with inguinal hernia who underwent SILS, there were 186 patients (3.8%) with incarcerated inguinal hernia (IIH). Of these, there were 153 male children (82.3%) and 33 female children (17.7%). The median age was 18 months (ranging from 1 month to 12 years). At the time of surgery, 28.5% of the cases had the incarcerated contents spontaneously returned to the abdominal cavity. The hernia contents included bowel (50.5%), greater omentum (14%), and ovary (7%). All cases of incarcerated hernia contents were successfully returned to the abdominal cavity, with no cases requiring additional trocars or conversion to open surgery. One case of necrotic and perforated cecum was brought out through a small expanded umbilical incision for management, and one case required removal of a necrotic ovary. The rate of detecting a contralateral patent processus vaginalis was 36.6%. The median operating time was 24 minutes (for one side) and 30 minutes (for two sides). The median hospital stay was 1 day (1-3 days). The median follow-up time was 54 months (12-106 months), and no hydrocele, undescended testis, or testicular atrophy was observed due to the surgery. The recurrence rate of inguinal hernia was 1.1%. Conclusion: This study shows that SILS for the treatment of incarcerated inguinal hernia in children is feasible, safe, has a low recurrence rate, and offers excellent cosmetic results.
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Keywords
laparoscopic percutaneous suture, incarcerated inguinal hernia, children
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