Laparoscopic Totally Extraperitoneal Repair in a Pediatric Patient for Recurrent Inguinal Hernia

Abstract

Introduction:

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repairs are common in adults but have not previously been reported in the pediatric population. This video, with a run time of 4 minutes 46 seconds, demonstrates an effective laparoscopic TEP repair in a 10-year-old boy presenting with a recurrent left inguinal hernia after three previous failed anterior repairs, including prior synthetic absorbable mesh placement.

Methods:

Given the likelihood of significant scarring and possible inguinal floor weakness, an anterior approach was felt to carry a high risk of injury in this patient. We decided to perform a laparoscopic TEP repair to minimize the chance of damage to cord structures with lightweight polypropylene mesh placement to reinforce the repair.

Results:

Access to the extraperitoneal space is obtained through a 10-mm infraumbilical incision in standard manner; two 5-mm ports are placed lateral to midline to increase the working space in a smaller body habitus. Blunt dissection frees attachments to the inguinal floor, but a tightly adhered indirect hernia sac is unable to be bluntly reduced. The omentum-containing hernia sac is sharply transected, reduced, and closed with endoloops. The spermatic cord is carefully skeletonized and lightweight monofilament polypropylene mesh is secured with a single staple in Cooper's ligament and fibrin glue.

Conclusion:

This is the first report of a laparoscopic TEP hernia repair in a child. We conclude that a laparoscopic TEP approach may be considered in select cases of recurrent pediatric hernias following prior failed anterior repairs, with specific adaptations intended for the pediatric patient. Research which aided the creation of the video can be found in the reference list. ^{1 –23}

No competing financial interests exist.

Runtime of video: 4 mins 46 secs