Laparoscopic Hernia Repair

In children, the development of an inguinal hernia occurs when the processus vaginalis, or the tract where the ovaries or testes descend while the patient is in utero, fails to close following birth. This was originally repaired through a small incision in the groin, but since 2014, the use of laparoscopic techniques has been employed at Children's Mercy. This technique uses a small camera placed through the umbilicus and the percutaneous use of suture to close the defect, resulting in less disruption of the surrounding tissue. The repair of inguinal hernias on both sides can be performed through the same incisions. This is most often performed as an outpatient procedure, where children go home the same day after surgery and only require Tylenol or ibuprofen for pain control.

A recent retrospective review of 800 patients who underwent laparoscopic inguinal hernia repair at our institution was recently accepted for publication in the Journal of Pediatric Surgery. In this review, only 2.5% developed a recurrence, similar to previous research, with other complications decreasing as our experience with laparoscopic repair has grown. Recurrent inguinal hernias can also be re-repaired laparoscopically with no difference in operative time.

The pathophysiology underlying the development of inguinal hernias is different for children, who have a congenitally patent processus vaginalis, compared to adults, where the hernia is often due to a weakness in the musculature that requires mesh placement for repair. What is unknown is whether inguinal hernias that develop during the teenage years are due to a persistent patent processus vaginalis or due to a weakness in the abdominal musculature. An observational study is currently ongoing that aims to answer this question by following adolescent patients who undergo laparoscopic inguinal hernia repair without mesh placement to identify the recurrence rate and need for reoperation.

Watch video on a laparoscopic inguinal hernia repair using the Zygomatic Arch Awl.