Our Summary

This research paper compares two surgical techniques used to treat pediatric inguinal hernia (a condition where a part of the intestine protrudes through a weak spot in the abdominal muscles): laparoscopic percutaneous extraperitoneal closure (LPEC) and conventional open repair (OR). The researchers looked at the medical records of 570 children who had undergone either of these surgeries.

They found no significant difference in the rates of complication or recurrence between the two methods. However, the LPEC group had a slightly higher rate of complications related to the surgical site, such as minor deformities and infections. On a positive note, none of the children treated with LPEC experienced a hernia on the other side of their body (contralateral metachronous IH), whereas about 4% of the children treated with OR did.

The researchers concluded that both methods are effective for treating pediatric inguinal hernia, with LPEC potentially being superior in preventing hernias on the opposite side. However, they also highlighted the need to address the slightly higher rate of surgical site complications in LPEC. They also pointed out the need for longer-term studies to assess potential impacts on male fertility for patients treated with LPEC.

FAQs

  1. What are the two surgical techniques discussed in this research paper for treating pediatric inguinal hernia?
  2. Did the study find any significant difference in the rates of complication or recurrence between the two surgical methods?
  3. What potential impacts on male fertility were mentioned in the study regarding patients treated with LPEC?

Doctor’s Tip

In discussing pediatric hernia repair with a patient, a doctor may advise that both laparoscopic percutaneous extraperitoneal closure (LPEC) and conventional open repair (OR) are effective treatment options. They may also mention that LPEC may have a lower risk of contralateral metachronous inguinal hernia, but a slightly higher risk of surgical site complications. It is important for the patient to follow their doctor’s post-operative care instructions carefully to minimize the risk of complications and ensure a successful recovery. Additionally, long-term follow-up may be necessary to monitor for any potential impacts on male fertility for patients treated with LPEC.

Suitable For

Pediatric patients who are recommended for pediatric hernia repair typically have inguinal hernias, which are more common in boys than in girls. Inguinal hernias in children are usually diagnosed during the first few months of life, but can also be detected later in childhood. Children with inguinal hernias may present with a visible bulge in the groin area, discomfort or pain, or a feeling of heaviness in the groin.

Surgery is usually recommended for pediatric patients with inguinal hernias to prevent complications such as incarceration (when the herniated intestine becomes trapped and blood flow is compromised) or strangulation (when the blood flow to the herniated intestine is completely cut off). Pediatric hernia repair is a common procedure with a high success rate, and most children recover well with minimal complications.

In conclusion, pediatric patients who are typically recommended for pediatric hernia repair are those with diagnosed inguinal hernias, especially if they are experiencing symptoms or if the hernia is at risk of complications. Both laparoscopic percutaneous extraperitoneal closure (LPEC) and conventional open repair (OR) are effective surgical techniques for pediatric hernia repair, with LPEC potentially having some advantages in terms of preventing contralateral metachronous inguinal hernias. However, the choice of surgical technique should be based on individual patient factors and the expertise of the surgical team.

Timeline

Before pediatric hernia repair:

  1. Patient may experience symptoms such as a visible bulge in the groin area, discomfort or pain, especially when crying, coughing, or straining.
  2. Patient undergoes a physical examination by a healthcare provider to confirm the presence of a hernia.
  3. Patient may undergo imaging tests such as ultrasound to further evaluate the hernia.
  4. Surgery is scheduled based on the severity of the hernia and the patient’s overall health.

After pediatric hernia repair:

  1. Patient is taken to the operating room and given anesthesia.
  2. Surgeon performs the chosen surgical technique (LPEC or OR) to repair the hernia.
  3. Patient is monitored in the recovery room for a period of time before being discharged home.
  4. Patient may experience some pain, swelling, or bruising in the surgical area, which can be managed with pain medication.
  5. Patient is advised to avoid strenuous activities and heavy lifting for a period of time to allow for proper healing.
  6. Patient follows up with their healthcare provider for post-operative care and monitoring for any complications or recurrence of the hernia.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pediatric hernia repair include:

  1. What are the different surgical techniques available for pediatric inguinal hernia repair, and what are the potential benefits and risks of each?
  2. How do the rates of complications and recurrence compare between laparoscopic percutaneous extraperitoneal closure (LPEC) and conventional open repair (OR)?
  3. What are the potential long-term effects of each surgical technique, such as impacts on male fertility?
  4. What is the likelihood of developing a hernia on the opposite side of the body (contralateral metachronous IH) after surgery, and how does this risk differ between LPEC and OR?
  5. What steps can be taken to minimize the risk of surgical site complications, such as minor deformities and infections, associated with LPEC?
  6. Are there any specific factors about my child’s health or medical history that may influence the choice of surgical technique for their hernia repair?
  7. What is the expected recovery time and post-operative care required for each surgical technique?
  8. Are there any alternative treatment options or non-surgical approaches that could be considered for pediatric hernia repair?
  9. How frequently should follow-up appointments be scheduled after surgery, and what signs or symptoms should I watch for that may indicate a complication or recurrence?
  10. Are there any additional resources or support services available to help my child and our family navigate the process of pediatric hernia repair?

Reference

Authors: Kurobe M, Sugihara T, Harada A, Kaji S, Uchida G, Kanamori D, Baba Y, Hiramatsu T, Ohashi S, Otsuka M. Journal: Asian J Endosc Surg. 2022 Apr;15(2):290-298. doi: 10.1111/ases.12997. Epub 2021 Oct 3. PMID: 34605204