Laparoscopic treatment of recurrent inguinal hernia in children

The authors report their experience with the laparoscopic treatment of recu rrent inguinal hernia in children. Between April 1993 and January 1998, 225 boys aged 8 months to 14 years (mean 4.4 years) were treated laparoscopica lly for a hydrocele, spermatic-cord cyst, or hernia. Ten boys had recurrent inguinal hernias after conventional surgery, in one case bilateral. The te chnique requires 3 trocars: a 0 degrees, 5-mm telescope inserted through th e umbilicus and two 3-mm trocars placed 3-4 cm below the umbilicus on eithe r side. Simple patency of the peritoneal vaginal duct (dpv) was found in ei ght cases and a direct inguinal hernia in three. In cases with an open dpv, we opened the external hemicircumference of the heck in order to bring the conjoined tendon closer to the crural arch with a non-resorbable 4/0 sutur e, and then placed a 3/0 resorbable pursestring suture around the peritoneu m of the internal orifice of the inguinal canal. In direct inguinal hernias the orifice was closed by placing 2-3 nonabsorbable 3/0 sutures between th e two muscular sides of the hernial defect. There were no intra- or postsur gical complications. All patients, at a maximum follow-up of 3 years showed total recovery from the hernia. Our early results suggest that laparoscopi c surgery is a feasible and safe technique for the treatment of recurrent i nguinal hernia in children.