Laparoscopic Repair of Pediatric Inguinal Hernia by Disconnection of the Hernial Sac

Abstract
Background: Several techniques are used for laparoscopic treatment of pediatric inguinal hernia (PIH). Disconnection and peritoneal closure was described by Becmeur in 2004, as an effective technique mimicing open technique. Others described disconnection only as an effective laparoscopic treatment of PIH specially for small defects. Here in, we describe the short term results of laparoscopic disconnection only of the hernial sac.
Patients and Methods: This prospective clinical study was carried out in the Pediatric Surgery Unit, Tanta University Hospital, during the period from March 2016 to March 2017, on 15 patients with 20 pediatric inguinal hernias. All the cases were subjected to laparoscopic disconnection of the hernia sac without closure of peritoneum over internal ring.
Results: The operative data as well as postoperative course and complications specially recurrence were reported. Twenty hernias were repaired laparoscopically by disconnection of sac only. Operative time ranged from 30 to 42 minutes for unilateral cases while in bilateral cases, it ranged from 35 to 50 minutes. All cases were repaired laparoscopically with no conversion. Three recurrences occurred, all with ring diameter more than 10mm.
Conclusion: With enough experience LIHR is safe, feasi-ble, and has no major complications and a small incidence of minor complications. With experienced hands U/S is a good tool for examining the contralateral side in unilateral PIH and for detection of a CPPV (a latent hernia). sac disconnection is an effective laparoscopic treatment of PIH. However, it is associated with an unacceptable recurrence rate (15%) in hernias >10mm in diameter. However, IRD is not the only factor contributing to recurrence.