Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients of all ages

Background/Purpose: The recurrence rate in laparoscopic inguinal hernia (LIH) repair remains high. The aim of this study was to assess whether the introduction of technical improvements, including (1) decreasing tension on the purse-string knot when closing the internal hernia opening by injecting normal saline extraperitoneally, (2) using an airtight knot, and (3) stress-testing the airtightness of the knot by increasing intraperitoneal gas pressure, could eliminate recurrence in LIH repair in pediatric patients of all ages. Methods: A retrospective review was performed of the prospectively collected data of 451 LIH repairs in 314 children of various ages in our institution from September 2002 to September 2006. The technical improvements mentioned above to prevent recurrence were introduced in the second half of the series of operations (tensionless repair [TL]). The data on both groups of operations were then compared. Results: A total of 225 hernias were repaired in the first group (164 patients), compared with 226 in the TL group (150 patients). The differences between the ratio of boys to girls (129:35 vs 112:38) and the mean ages (50.84 +/- 48.15 vs 45.59 +/- 47.95 m) in the 2 groups were not statistically significant. The recurrence rate in the TL group was much lower than in the first group (0.4% vs 4.88%, P=.003). There was no postoperative testicular atrophy in either group of patients. Conclusion: It is possible to achieve a near-zero recurrence rate in laparoscopic hernia repair in pediatric patients of all ages. (c) 2007 Elsevier Inc. All rights reserved.