Endovideosurgical treatment of children with hernias of the anterior abdominal wall

Abstract

Laparoscopic operations in children with various types of hernias of the anterior abdominal wall are performed by us since 1994. During this time, more than 3000 sugical interventions were performed in children aged from 10 days to 18 years. Most patients had indirect inguinal hernias. The original laparoscopic technique consisted in hermetic sealing of the hernial orifices. In 15% of patients, was diagnosed a bilateral hernia, which did not appear clinical signs until laparoscopic intervention. Depending on the size of the hernial orifices, hernias were divided on small hernias (inguinal ring up to 1 cm) - 768 children (relapse - 0.26%), medium size hernia (inguinal ring from 1 to 2.5 cm) - 1726 people (relapse - 0.11%), large hernias (inguinal ring more than 2.5 cm) - 227 people (relapse - 5.7%). During repeated interventions, it was found that the relapse of the disease is associated with a defect in sealant sutures at large hernial gates. The technique of surgery for hernias of a large size is supplemented by a double seam of the inner inguinal ring, which allows to minimize the tension of the tissues. Rare hernias of the abdominal wall were encountered in 9 cases. In 5 children were found a femoral hernia, corrected by laparoscopic isolation and mobilization of the hernial sac, followed by plastic surgery of the defect in the abdominal wall with a vicryl mesh. In two cases in the hernial sac an omentum was fixed. Children were examined 6 months after the operation - no pathology was found. In 3 patients during laparoscopy, a direct inguinal hernia was diagnosed. The hernial defect was sowed after complete mobilization and separation of the hernial sac without the usage of a mesh implant. Endovideosurgery today successfully competes with traditional methods in the treatment of various hernias of the abdominal wall in children, allowing to determine the type of hernia, to improve the technique of surgery in time, perform radical intervention atraumatically with respect to the sex gland.