Laparoscopic inguinal hernia repair in children

This video shows short clips from several cases to demonstrate the approach to laparoscopic repair of inguinal hernia in children, which involves dissection and removal of the hernia sac and closure of the peritoneal defect. No mesh is used.

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Laparoscopic   inguinal   hernia   repair   in   children

Authors
F Becmeur
Abstract
This video shows short clips from several cases to demonstrate the approach to laparoscopic repair of inguinal hernia in children, which involves dissection and removal of the hernia sac and closure of the peritoneal defect. No mesh is used.
Catégorie
basic techniques
Mots-clés
pediatrics,operation,inguinal hernia repair surgery
Type de vidéo
Durée
06'00''
Publication
2002-12
Popularité
Favoris
Favorites Media
Audio
en
Sous-titres
en
E-publication
WeBSurg.com, Dec 2002;2(12).
URL: http://www.websurg.com/doi-vd01en1352e.htm

Laparoscopic   inguinal   hernia   repair   in   children

1. Case presentation 00'11''
Since 1995, there have been numerous reports in the literature of laparoscopic hernia repair performed in children. The patient is positioned in a froglike position under general anesthesia. The surgeon stands at the head of the patient facing the feet and the monitor is placed at the foot of the table. We begin with an open trocar placement opening the peritoneal fold within the umbilicus. In this case, we are using a 5mm strip trocar, which allows a narrow port hole through the abdominal wall. Two 3mm trocars are placed laterally below or at the level of the umbilicus depending on the age of the child. This is a right-sided hernia in a girl. Dissection of the peritoneum begins on the external part of the sac and a little bit inside the internal inguinal ring in order to keep enough tissue to close the peritoneum afterwards. This is a left-sided hernia in a girl. In this case, the round ligament will be coagulated and cut. A purse-string suture is then performed. The procedure is completed with an intracorporeal knot. This is the inner view of the left-sided hernia in a boy. The spermatic vessels are below on the left of the screen and the vas is on the right. It is a very large hernia. On the right side, there is nothing to be done. Dissection is as for the previous case. It is necessary to avoid however the vessels and the vas in the male. One must set the sac free from the peritoneum. This is another view of a left-sided hernia in a boy. This is the internal view of a right-sided hernia in a boy and the end of the dissection. Because it is not possible to introduce the needle through any of the 3mm trocars, one must insert the needle directly through the abdominal wall. This is a right-sided hernia in a girl. A few months after a left-sided hernia repair in a boy, the hernia was noted to be still present. Of course, it was not because of a patent process vaginalis but actually a direct left-sided inguinal hernia and the omentum was protruding through the hernia. The sac is drawn toward the peritoneal cavity and divided with the stapler.