On our last trip, I explained what is inguinal hernia and hydrocele in children was. In this course, we will talk about how to choose which method to treat inguinal hernia.
Have a good time.
Let’s make a short reminder first. I explained that the membrane surrounding the organs in the abdomen extends into the inguinal canal like a glove finger in order to have a hernia. If we connect this extension from where it comes out of the abdomen, we can prevent the organs in the abdomen from entering into the hernia sac and therefore prevent strangulations or incarcerations that may occur.
In the previous course, I explained that it is recommended to be done within the first 15 days in case of diagnosis in the outpatient clinic, referring to a study conducted in Canada.
So how do we correct it? Should we do open surgery or laparoscopically?
So should we repair it with an incision we will make over the fold line in the groin, or shall we see and repair the opening with the help of a camera we insert through the umbilicus?
There are dozens of studies on this subject.
Meta-analysis is an attempt to combine the results of multiple studies on a specific subject, independent of each other, and to perform the statistical analysis of the findings.
In a systematic study conducted with this method, 375 laparoscopic hernia repair patients and 358 openly treated patients were compared. The duration of the operation, hospital stay, recovery times, and recurrence rates were examined, and it was found that there was no significant advantage in both techniques.
In 2016, the International Paediatric Endosurgery Group (IPEG) published that the operation time is shorter with laparoscopic surgery and the postoperative complication rates are lower, especially in case of bilateral inguinal hernia.
It is known that after the age of 2, the processus vaginalis, in other words the hernia canal or the hernia sac, can be open in up to 40% of children. Hernia may develop clinically in 25-50% of them. Here, laparoscopy allows us to see if the canal of the opposite side is open and to repair it at the same time. Whether or not to close open hernia sacs that do not cause clinical problems is a different discussion. Personally, if I see an open sac on the left while repairing the right inguinal hernia laparoscopically, I also close the opening on that side.
A study conducted by a committee of the European Association of Paediatric Surgeons was published this month. Out of 5173 studies written on this subject, 72 out of 5173 studies and 27 meta-analyses were examined and the result was published in the European Journal of Paediatric Surgery. It has been reported that laparoscopic repair may be more beneficial, especially in bilateral inguinal hernias, but no significant difference was found in the comparison of laparoscopic and open techniques in other subjects. For the timing of the surgery, a special approach to the patient was recommended, taking into account the experience and conditions of the surgical team.
Long story short, in the light of many publications I read and my personal experience, I can say this: The only advantage of laparoscopic treatment over open treatment is that if there is a hernia on one side, laparoscopy can show whether there is one on the other side. If there is bilateral inguinal hernia, or if there is an inguinal hernia and an umbilical hernia at the same time, I prefer laparoscopic repair. If there is a unilateral hernia, I discuss all this with the parents frankly and decide with them whether to do it open or laparoscopically.
We have come to the end of another course. You can find the link of the literature I mentioned below.
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