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Live Event Content
Focus on Technique- Laparoscopic Pediatric Hernia Repair 2015
With Dr. Matthias Bruzzoni
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Laparoscopic hernia repair in preemies rarely recurs; recurrences are more common in older children
The speaker has had two preemies spit out the stitch without hernia recurrence, suggesting the suture may act as a seton
In rabbit model at 2 weeks: suture alone stayed closed in 25% after suture removal; with anterior injury 87% stayed closed
In rabbit model at 4 weeks: suture alone stayed closed in 17%; with anterior injury 100% stayed closed even at 36mmHg pressure
Silk suture (braided) had better closure rates than Vicryl or Prolene (monofilament) in rabbit model without injury
The speaker has had two stitch abscesses in preemies using braided suture; both hernias stayed closed
The speaker has had two hydroceles form after laparoscopic repair, both on asymptomatic contralateral sides repaired with SEAL technique
In adolescent hernia series (13-18 years, 5-year follow-up), recurrence rate was 3% with open high ligation
Modified SEAL technique (two-pass suture ligature) has 1.4% recurrence rate in 210 repairs over 4 years
Single-pass SEAL technique has 2-3% recurrence rate
Mayo Clinic study and others show that direct hernias may be the most common cause of pediatric hernia recurrence
When adult hernia surgeons see pediatric recurrences, they are finding direct hernias not indirect
Grossfeld found 30% of recurrences are direct hernias
Felix Schier's original laparoscopic hernia recurrence rate was 6%, more recent data 3%
Craig Albanese and Sanjeev Dutta reported 1.5% recurrence with the SEAL repair
CK Young has had one or two recurrences in over 2000 laparoscopic hernia repairs
In 50-year Mayo Clinic follow-up study, 5% of hernia patients were infertile, similar to general population
Javetz study: 6% of 8500 fertility clinic patients had prior hernioplasty; those with hernia repair had markedly reduced semen quality
In the UK, open hernia repair involves dividing the sac without ligation, with recurrence rates equivalent to traditional ligation
Adult hernia surgeons report 10-15% incidence of chronic pain with mesh repair; one study showed 30%