Single-Incision Pediatric Endosurgical Epigastric Hernia Repair

Abstract

Introduction:

Epigastric hernias represent about 4% of all abdominal hernias in children and require surgical repair. Traditionally, these hernias are repaired by an open surgical technique. More recently, laparoscopic epigastric hernia repairs have been described using two trocars in the upper abdomen. ¹ Single-incision pediatric endosurgery (SIPES) has been described for virtually scarless inguinal hernia repair. ² In this video presented at IPEG's 22nd Annual Congress for Endosurgery in Children, ³ we describe a corresponding novel SIPES technique for epigastric hernia repair.

Materials and Methods:

Patients with symptomatic epigastric hernias, which were deemed to be too far superior (4 to 7 cm) to be repaired with an open technique through an umbilical incision, were selected for SIPES repair. Two trocars (5 and 3 mm) were introduced through a single umbilical incision and a 30° 5 mm endoscope was introduced, directing the optical angle anterior toward the abdominal wall. After location of the epigastric hernia, the overlying peritoneum was opened and cleared around the defect. Incarcerated preperitoneal fat in the defect was removed. The hernia repair was subsequently performed using looped 4-0 polypropylene sutures introduced through a 17-gauge spinal needle in a lasso technique as demonstrated in the video.

Results:

Four girls (age 4.4 to 7.9, median 4.9 years) underwent single-incision endosurgical epigastric hernia repair. The mean operative time was 24±6 minutes, and there were no intraoperative complications. All patients were discharged home from the recovery room on the day of surgery. All patients were followed up 2 to 3 weeks after the operation, with no recurrence and excellent cosmetic results. No residual or recurrent epigastric hernia was noted and the patients were pain free. So far, a recurrence-free long-term follow-up is available on all patients at an interval of 7–12 months.

Conclusions:

Epigastric hernias represent about 4% of all abdominal hernias operated upon in children. They are about twice as likely to occur in girls and typically present with a circumscribed midline epigastric abdominal mass that may be painful or tender. ⁴ Symptomatic, surgical repair is usually recommended. Traditionally, epigastric hernias have been repaired through a transverse incision directly overlying the palpable hernia. The subcutaneous tissue is dissected down to the fascia, the incarcerated preperitoneal fat is removed, and the defect is closed with interrupted sutures. ⁵ This leaves a conspicuous scar on the patient's epigastium. Our described SIPES technique offers a virtually scarless, quick, and simple option for repair of symptomatic epigastric hernias that can be performed with a standard laparoscopic equipment and excellent postoperative results.

Dr. Muensterer received funding from KARL STORZ Endoscopy-America, Inc., for another study. The other authors have no financial interests or conflicts to disclose.

Runtime of video: 3 mins 59 secs

This video was originally presented on June 21, 2013, at IPEG in Beijing, China.