The role of laparoscopy in the management of suspected recurrent pediatrichernias

Background: This report examines recurrent pediatric groin hernias and the role of diagnostic laparoscopy in the management of these recurrences. Methods: A chart review of 19 children presenting with recurrent hernias wa s performed, analyzing the type of primary hernia, nature of recurrence, pr eexisting medical conditions, surgical complications at primary repair, and time to recurrence. Diagnostic laparoscopy (DL) was used during the remedi al repair of the last nine patients. Results: Seventeen indirect hernias were repaired during the primary repair , and 1 femoral hernia was identified. In one child, no inguinal hernia was identified at the initial operation. Overall, 11 recurrences were found to consist of indirect sacs, and 4 were found to have attenuation of the ingu inal floor. Four additional recurrences were found to be femoral hernias. I n only 1 patient was a wound factor (infection) thought to play a role in t he recurrence. Diagnostic laparoscopy in 9 patients found 4 (44%) to have u nsuspected intraoperative findings. Four femoral hernias were identified (3 with unsuspected contralateral femoral hernias). Additionally, 1 unsuspect ed recurrence of an indirect sac was identified. Conclusions: Laparoscopy accurately identifies the nature of the defect in children with recurrent groin hernias, detecting unsuspected contralateral indirect, direct, or femoral hernias in 44% of those undergoing laparoscopy .