Minimally Invasive Surgery for Inguinal Hernia in Children:
¡@¡@Traditionally, standard surgical repair is performed via an open inguinal exploration. This has the disadvantages of not only requiring a bigger incision and carries the risk of damage to the vas deferens and testicular vessels, but also the inability to reliably exclude the presence of a contralateral hernia, which occurs in about 20-30% of cases. As a result many paediatric surgeons, especially those in North America, have been advocating routine exploration of the contralateral side in order to avoid a subsequent second operation and general anaesthesia. ¡@¡@The Division of Paediatric Surgery and Paediatric Urology, The Chinese University of Hong Kong has pioneered a new method combining the use of the laparoscope and a specially made herniotomy hook, which was designed by and named after the Division Head, Professor Yeung Chung Kwong, to repair inguinal hernia in infants and children. ¡@¡@Under the magnified view with the laparoscope, the anatomy of the hernial defect and its nearby important structures like the vas deferens and testicular vessels can be very clearly visualized. More importantly, the presence or absence of a contralateral hernia can be assessed with absolute certainty at the same time, thus avoiding any unnecessary exploration. The specially designed herniotomy hook allows complete dissection and ligation of the hernial sac under laparoscopic guidance, while safeguarding the vas and testicular vessels. If a contralateral hernia is present this can be easily repaired in a similar fashion at the same time, thereby eliminating the risk of a subsequent contralateral hernia and the need for a second operation. The procedure is performed as Day Surgery and all patients will be discharged home on the same day. As post-operative pain is usually minimal, nearly all children can resume normal activities and return to school the day immediately after the procedure. The resulting wounds are tiny and would become almost invisible in a few weeks' time. ¡@¡@Since October 2000 the division has successfully performed laparoscopic herniotomy using the technique described in 325 infants and children at the Prince of Wales Hospital. All patients recovered uneventfully, with no intra- or post-operative complications encountered. On follow-up, all patients remained well with excellent cosmetic results. There were only 2 recurrences (0.6%), which compares favourably with published results using the traditional or standard open approach. ¡@¡@Our experience shows that this new technique has distinct advantages of shorter operative time, smaller wounds with minimal post-operative pain, less analgesic requirement, more rapid recovery, excellent cosmetic effects with nearly invisible scars, and high effectiveness with extremely low recurrence rates. Most importantly, this new technique allows accurate assessment for any contralateral hernia, thus avoiding the need for unnecessary contralateral exploration yet at the same time eliminates the risk for a second operation. In cases of acute obstruction, this approach also enables assessment of the viability of the strangulated bowel and other intra-abdominal organs, thus providing extra safety over the traditional open approach. We believe this novel minimally invasive technique of laparoscopic herniotomy should become the new gold standard for hernia repair in infants and children.
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