Comparison of laparoscopic percutaneous extraperitoneal closure versus conventional herniotomy in extremely low birth weight infants

PurposeLaparoscopic percutaneous extraperitoneal closure (LPEC) has become routine for repairing pediatric inguinal hernia (IH). Reports on the effective repair of IH in challenging cases, such as extremely low birth weight infants (ELBWI) who become symptomatic soon after birth and have surgery before 1year of age, are rare; and conventional herniotomy (CH) in ELBWI requires extensive experience of neonatal surgery. We compared LPEC with CH for treating ELBWI with IH.MethodsConsecutive ELBWI with IH treated by either LPEC (n=17) or CH (n=22) before 1year of age between 2012 and 2017 were reviewed. LPEC were performed by consultant pediatric surgeons (CPS; n=3) with experience of at least 200 cases each. In CH, 11 cases were treated by CPS and 11 by CPS-supervised surgical trainees.ResultsThere were no intraoperative complications. Operative time and anesthesia time for bilateral IH repairs were both shorter in LPEC. Postoperative sequelae were recurrence (LPEC; n=1; repaired by redo LPEC 2 months after the initial repair) and intravenous rehydration (CH; n=1; for persistent post-anesthetic vomiting). Recovery was unremarkable in all cases without additional analgesia.ConclusionLPEC would appear to be a viable option for treating IH in ELBWI, especially bilateral cases.