The advantages of transumbilical single-site laparoscopic percutaneous extraperitoneal closure for inguinal hernia in 1583 children.

BACKGROUND: There have been numerous surgical procedures for inguinal hernia in children, and recently the novel technique of single-site laparoscopic procedure was introduced. This study aimed to analyze the safety and efficacy of single-site laparoscopic hernia repair in a large number of children, while compared with the traditional open surgery.

METHODS: From January 2012 to June 2015, we performed transumbilical single-site laparoscopic percutaneous extraperitoneal closure (TSLPEC) in 1583 patients, including bilateral hernia in 135 cases, and unilateral hernia in 1448 cases (left side in 582, right side in 866). From January 2007 to January 2010, we performed open inguinal hernia repair in 355 patients, including bilateral hernia in 52 cases, and unilateral hernia in 303 cases. Operating time, recurrence rate, incidence of contralateral hernia, and prevalence of contralateral patent processus vaginalis (cPPV) were recorded and compared.

RESULTS: A total of 1583 patients underwent TSLPEC, without conversion to open surgery. For unilateral repair, the average operating time in TSLPEC group was shorter than open repair group (19.3 ± 6.1 vs. 28.0 ± 8.9, p < 0.05), and it was much shorter than open repair group for bilateral repair (26.2 ± 9.5 vs. 49.8 ± 12.9, P p < 0). The left hernia had higher prevalence of cPPV than right hernia (48.1% vs. 38.5%, p < 0.05). The wound recovered well with good cosmetic appearance in TSLPEC group. Hernia recurrence occurred in seven cases (0.4%) of TSLPEC group, and six cases (1.7%) of open repair group ( p < 00.05). No contralateral hernia developed in TSLPEC group, while 17 cased (5.6%) had contralateral hernia in open repair group ( p < 00.05).

CONCLUSIONS: TSLPEC is an effective and safe procedure for inguinal hernias with lots of advantages, including short operating time, simultaneous management of cPPV, excellent cosmetic appearance, low incidence of contralateral hernia, and low recurrence rate. This procedure could be recommended as a routine treatment for inguinal hernias in children.