Laparoscopic inguinal herniotomy: Recreating the open operation optimises outcomes
•Laparoscopic inguinal herniorrhaphy is associated with higher recurrence rates compared to open herniotomy.•Our laparoscopic herniotomy (LIH) cohort shows low recurrence (1%), despite risk factors.•Our data supports growing favourable evidence on laparoscopic sac division techniques. Recent evidenc...
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| Veröffentlicht in: | Journal of pediatric surgery 2022-02, Vol.57 (2), p.271-274 |
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| creator | Ducey, Jonathan Peters, Robert T Wilkinson, David J Verhoef, Christian Lansdale, Nick |
| description | •Laparoscopic inguinal herniorrhaphy is associated with higher recurrence rates compared to open herniotomy.•Our laparoscopic herniotomy (LIH) cohort shows low recurrence (1%), despite risk factors.•Our data supports growing favourable evidence on laparoscopic sac division techniques.
Recent evidence suggests simple laparoscopic inguinal herniorrhaphy is associated with higher rates of recurrence and testicular ascent. We instigated a standardised approach to laparoscopic inguinal herniotomy (LIH), with circumferential sac division and ‘purse-string’ closure (4/0 monofilament polypropylene). An active follow-up programme was pursued. We reviewed our outcomes of this technique and compared them to an open herniotomy (OIH) cohort.
LIH patients were identified prospectively (2017–2021): OIH retrospectively from 2016. Risk factors for complications were defined: extremely to very preterm ( |
| doi_str_mv | 10.1016/j.jpedsurg.2021.10.042 |
| format | Article |
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Recent evidence suggests simple laparoscopic inguinal herniorrhaphy is associated with higher rates of recurrence and testicular ascent. We instigated a standardised approach to laparoscopic inguinal herniotomy (LIH), with circumferential sac division and ‘purse-string’ closure (4/0 monofilament polypropylene). An active follow-up programme was pursued. We reviewed our outcomes of this technique and compared them to an open herniotomy (OIH) cohort.
LIH patients were identified prospectively (2017–2021): OIH retrospectively from 2016. Risk factors for complications were defined: extremely to very preterm (< 32 weeks), emergency presentation with incarceration, and redo surgery for recurrence. Data are presented as median [IQR]. Comparisons used Fisher's exact and Mann-Whitney U tests: significance defined as p < 0.05.
192 inguinal herniae in 140 patients were included in the LIH group and 214 herniae in 179 patients in the OIH group. Groups were similar in age and gender. The LIH group had a significantly larger proportion of cases that were premature, had emergency surgery, or had redo surgery after previous OIH. Follow-up was 24.4 months [10.8–33.6] vs. 66.4 [64.5–68.5] (LIH vs. OIH). Hernia recurrence occurred in 2/192 (1.0%) vs. 4/214 (1.9%) (LIH vs. OIH), p = 0.69. There was one known case of testicular ascent after OIH but none in the LIH group.
Recreation of the open herniotomy laparoscopically appears to confer excellent outcomes, with low rates of recurrence despite a high proportion of patients having known risk factors. Further long-term data on rates of testicular ascent after active follow-up are required.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2021.10.042</identifier><identifier>PMID: 34839949</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Hernia ; Hernia, Inguinal - surgery ; Herniorrhaphy ; Herniotomy ; Humans ; Infant ; Infant, Newborn ; Inguinal ; Laparoscopic ; Laparoscopy ; Male ; Outcomes ; Recurrence ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Journal of pediatric surgery, 2022-02, Vol.57 (2), p.271-274</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-f5c7c600da5525e56be6509c41b239fe8bcdb7ffff80bfaf7c14ba38e230ab33</citedby><cites>FETCH-LOGICAL-c368t-f5c7c600da5525e56be6509c41b239fe8bcdb7ffff80bfaf7c14ba38e230ab33</cites><orcidid>0000-0002-0076-935X ; 0000-0001-5165-8230</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpedsurg.2021.10.042$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34839949$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ducey, Jonathan</creatorcontrib><creatorcontrib>Peters, Robert T</creatorcontrib><creatorcontrib>Wilkinson, David J</creatorcontrib><creatorcontrib>Verhoef, Christian</creatorcontrib><creatorcontrib>Lansdale, Nick</creatorcontrib><title>Laparoscopic inguinal herniotomy: Recreating the open operation optimises outcomes</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>•Laparoscopic inguinal herniorrhaphy is associated with higher recurrence rates compared to open herniotomy.•Our laparoscopic herniotomy (LIH) cohort shows low recurrence (1%), despite risk factors.•Our data supports growing favourable evidence on laparoscopic sac division techniques.
Recent evidence suggests simple laparoscopic inguinal herniorrhaphy is associated with higher rates of recurrence and testicular ascent. We instigated a standardised approach to laparoscopic inguinal herniotomy (LIH), with circumferential sac division and ‘purse-string’ closure (4/0 monofilament polypropylene). An active follow-up programme was pursued. We reviewed our outcomes of this technique and compared them to an open herniotomy (OIH) cohort.
LIH patients were identified prospectively (2017–2021): OIH retrospectively from 2016. Risk factors for complications were defined: extremely to very preterm (< 32 weeks), emergency presentation with incarceration, and redo surgery for recurrence. Data are presented as median [IQR]. Comparisons used Fisher's exact and Mann-Whitney U tests: significance defined as p < 0.05.
192 inguinal herniae in 140 patients were included in the LIH group and 214 herniae in 179 patients in the OIH group. Groups were similar in age and gender. The LIH group had a significantly larger proportion of cases that were premature, had emergency surgery, or had redo surgery after previous OIH. Follow-up was 24.4 months [10.8–33.6] vs. 66.4 [64.5–68.5] (LIH vs. OIH). Hernia recurrence occurred in 2/192 (1.0%) vs. 4/214 (1.9%) (LIH vs. OIH), p = 0.69. There was one known case of testicular ascent after OIH but none in the LIH group.
Recreation of the open herniotomy laparoscopically appears to confer excellent outcomes, with low rates of recurrence despite a high proportion of patients having known risk factors. Further long-term data on rates of testicular ascent after active follow-up are required.</description><subject>Hernia</subject><subject>Hernia, Inguinal - surgery</subject><subject>Herniorrhaphy</subject><subject>Herniotomy</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Inguinal</subject><subject>Laparoscopic</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Outcomes</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1PwzAMhiMEYuPjL6AeuXQ4SZO2nEATX9IkJLR7lKbuyLQ2JWmR9u9JNcaVHJzo9Ws7fgi5obCgQOXddrHtsQ6j3ywYMBrFBWTshMyp4DQVwPNTMgdgLOWZLGbkIoQtQJSBnpMZzwpellk5Jx8r3WvvgnG9NYntNqPt9C75RN9ZN7h2f598oPGoh5hLhk9MXI_dFHyU3PQabGsDhsSNg3Ethity1uhdwOvf-5Ksn5_Wy9d09f7ytnxcpYbLYkgbYXIjAWotBBMoZIVSQGkyWjFeNlhUpq7yJp4CqkY3uaFZpXmBjIOuOL8kt4e2vXdfI4ZBxW8Y3O10h24MiknIMslFLqNVHqwmbho8Nqr3ttV-ryioCafaqiNONeGc9IgzFt78zhirFuu_siO_aHg4GDAu-m3Rq2AsdgZr69EMqnb2vxk_SYqMnQ</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Ducey, Jonathan</creator><creator>Peters, Robert T</creator><creator>Wilkinson, David J</creator><creator>Verhoef, Christian</creator><creator>Lansdale, Nick</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0076-935X</orcidid><orcidid>https://orcid.org/0000-0001-5165-8230</orcidid></search><sort><creationdate>202202</creationdate><title>Laparoscopic inguinal herniotomy: Recreating the open operation optimises outcomes</title><author>Ducey, Jonathan ; Peters, Robert T ; Wilkinson, David J ; Verhoef, Christian ; Lansdale, Nick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-f5c7c600da5525e56be6509c41b239fe8bcdb7ffff80bfaf7c14ba38e230ab33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Hernia</topic><topic>Hernia, Inguinal - surgery</topic><topic>Herniorrhaphy</topic><topic>Herniotomy</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Inguinal</topic><topic>Laparoscopic</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Outcomes</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ducey, Jonathan</creatorcontrib><creatorcontrib>Peters, Robert T</creatorcontrib><creatorcontrib>Wilkinson, David J</creatorcontrib><creatorcontrib>Verhoef, Christian</creatorcontrib><creatorcontrib>Lansdale, Nick</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ducey, Jonathan</au><au>Peters, Robert T</au><au>Wilkinson, David J</au><au>Verhoef, Christian</au><au>Lansdale, Nick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic inguinal herniotomy: Recreating the open operation optimises outcomes</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2022-02</date><risdate>2022</risdate><volume>57</volume><issue>2</issue><spage>271</spage><epage>274</epage><pages>271-274</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>•Laparoscopic inguinal herniorrhaphy is associated with higher recurrence rates compared to open herniotomy.•Our laparoscopic herniotomy (LIH) cohort shows low recurrence (1%), despite risk factors.•Our data supports growing favourable evidence on laparoscopic sac division techniques.
Recent evidence suggests simple laparoscopic inguinal herniorrhaphy is associated with higher rates of recurrence and testicular ascent. We instigated a standardised approach to laparoscopic inguinal herniotomy (LIH), with circumferential sac division and ‘purse-string’ closure (4/0 monofilament polypropylene). An active follow-up programme was pursued. We reviewed our outcomes of this technique and compared them to an open herniotomy (OIH) cohort.
LIH patients were identified prospectively (2017–2021): OIH retrospectively from 2016. Risk factors for complications were defined: extremely to very preterm (< 32 weeks), emergency presentation with incarceration, and redo surgery for recurrence. Data are presented as median [IQR]. Comparisons used Fisher's exact and Mann-Whitney U tests: significance defined as p < 0.05.
192 inguinal herniae in 140 patients were included in the LIH group and 214 herniae in 179 patients in the OIH group. Groups were similar in age and gender. The LIH group had a significantly larger proportion of cases that were premature, had emergency surgery, or had redo surgery after previous OIH. Follow-up was 24.4 months [10.8–33.6] vs. 66.4 [64.5–68.5] (LIH vs. OIH). Hernia recurrence occurred in 2/192 (1.0%) vs. 4/214 (1.9%) (LIH vs. OIH), p = 0.69. There was one known case of testicular ascent after OIH but none in the LIH group.
Recreation of the open herniotomy laparoscopically appears to confer excellent outcomes, with low rates of recurrence despite a high proportion of patients having known risk factors. Further long-term data on rates of testicular ascent after active follow-up are required.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34839949</pmid><doi>10.1016/j.jpedsurg.2021.10.042</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-0076-935X</orcidid><orcidid>https://orcid.org/0000-0001-5165-8230</orcidid></addata></record> |
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| subjects | Hernia Hernia, Inguinal - surgery Herniorrhaphy Herniotomy Humans Infant Infant, Newborn Inguinal Laparoscopic Laparoscopy Male Outcomes Recurrence Retrospective Studies Treatment Outcome |
| title | Laparoscopic inguinal herniotomy: Recreating the open operation optimises outcomes |
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