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Why Keyhole Surgery Is Preferred For Paediatric Inguinal Hernia

Dr Nada Sudhakaran

Dr Nada Sudhakaran

Paediatric Surgeon & Urologist

Laparoscopic Surgery Is the Preferred Surgical Method for Pediatric Inguinal Hernia

Inguinal hernias are a common occurrence in children, characterized by a swelling in the groin region. This condition can be addressed through two main surgical methods: traditional open surgery or the modern keyhole method, also known as laparoscopic surgery.

In this article, we aim to shed light on the advantages of laparoscopic surgery, using a real-life case study for better understanding.

What is Paediatric Inguinal Hernia?

Before delving into the treatment options, it’s essential to understand what pediatric inguinal hernia is and how it presents in children.

An inguinal hernia occurs when a portion of the intestine or fatty tissue pushes through a weakness in the abdominal muscles, resulting in a bulge in the groin area or, in boys, the scrotum. This condition is relatively common in children, particularly in boys and premature infants.

For a full article on Inguinal Hernias in children click HERE

Causes

The primary cause of pediatric inguinal hernia is an incompletely closed inguinal canal. During fetal development, the inguinal canal serves as a passageway for the testicles to descend from the abdomen into the scrotum in boys, and in girls, it’s associated with the round ligament of the uterus. After birth, this canal should close almost entirely, leaving just enough space for the spermatic cord in boys and the round ligament in girls. If this canal doesn’t close properly, a part of the intestine can slip through, causing a hernia.

Symptoms

The most prominent symptom of an inguinal hernia is a bulge in the area where the thigh and groin meet. You may notice this bulge when the child is standing, crying, or straining during a bowel movement, and it may disappear when the child is lying down or relaxed.

In some cases, children with an inguinal hernia may experience discomfort or pain in the area of the bulge, especially when they cough, bend over, or lift heavy objects. If the hernia is incarcerated (the intestine becomes stuck in the inguinal canal), symptoms may include vomiting, severe pain, a firm bulge, and redness or discoloration over the area. This condition requires immediate medical attention.

Treatment

When it comes to treating pediatric inguinal hernias, prompt surgical intervention is typically the recommended approach. The goal is to prevent complications like incarceration or strangulation of the hernia, which can occur if a portion of the intestine becomes trapped and its blood supply is cut off.

The condition usually necessitates surgical intervention, with two types of surgeries commonly performed: open surgery and laparoscopic surgery (keyhole surgery.

The Limitations of Traditional Open Surgery

In contrast to laparoscopic surgery, the traditional open method for treating inguinal hernias in children presents a few significant disadvantages.

Large Incision Size & Scaring: Traditional open surgery for inguinal hernias necessitates a sizable incision in the groin area to access the hernia. This cut may need to be even larger in older or larger children to ensure adequate access. Not only does this result in more extensive scarring post-surgery, but it also increases the potential for wound complications and discomfort during the healing process.

Open Surgery
Open surgery incisions – large in size to allow access to hand manipulation by surgeon

Limited Accessibility: One of the principal drawbacks of open surgery is its limited range of access. To repair a hernia, the surgeon must cut through the skin, fatty tissue, and muscle layers, which restricts their ability to visualize and explore the entire inguinal region. Conversely, laparoscopic surgery, with its camera-guided instruments, allows for comprehensive access and the opportunity to examine the contra-lateral side, potentially identifying any additional hernias that may be developing.

More Trauma & Longer Recovery Times: Because open surgery involves cutting through multiple layers—skin, fat, and muscle—to reach the hernia, it is considered more traumatic than the laparoscopic approach. This increased tissue trauma often translates into longer recovery times, more post-operative pain, and a delayed return to normal activities for the child.

The Advantages of Keyhole Surgery for Paediatric Inguinal Hernia

For over two decades, keyhole surgery, also known as laparoscopic surgery, has been the method of choice for performing inguinal hernia surgeries in both adults and children.

The reasons for this are clear when considering the procedure itself and the associated recovery times.

Less Invasive: As the incisions are significantly smaller, the procedure is less invasive, leading to quicker recovery and less postoperative pain.

Pediatric Appendicitis Surgery
Keyhole surgery incisions – 3 small dots to insert camera and two instruments.

Reduced Scarring: Due to the minimalistic incisions, scarring is significantly reduced compared to open surgery.

Ability to Check the Other Side: One major advantage is the ability to use the camera to inspect the opposite side of the hernia. This allows the surgeon to identify any developing hernias and repair them during the same procedure, preventing a potential second surgery.

Identification of Internal Issues: The keyhole method also provides the opportunity to check for any internal injuries or abnormalities, such as problems with the ovaries or fallopian tubes in girls.

The story of my 6 year old patient and his case of Inguinal Hernia

Allow me to share with you a real-life scenario that showcases the effectiveness of laparoscopic surgery in treating pediatric inguinal hernia. The case involves a six-year-old child who came to me with a hernia on his left side. This was a particularly interesting case because the child had undergone a hernia repair on his right side just a year before.

His parents were naturally concerned about the recurrence of the hernia and wondered why it was happening again. They were also worried about the potential for another hernia on the opposite side in the future. To address this, I decided to employ the laparoscopic technique.

During the surgery, I inserted a camera into the child’s abdomen. This allowed me to get a clear view of the hernia, which I was able to repair effectively. One of the great advantages of laparoscopic surgery is the ability to examine the other side of the abdomen. So, after repairing the hernia on the left side, I swung the camera over to the right side, where the previous surgery had been done, to check for any signs of a new hernia.

This examination gave us the good news that there was no hernia developing on the right side. This ability to check both sides during a single operation is a distinct benefit of laparoscopic surgery and helps prevent the need for additional surgeries. Not only was I able to reassure myself of the effectiveness of our treatment, but I could also provide the parents with the peace of mind they were seeking.

This case highlights the unique benefits of laparoscopic surgery for pediatric inguinal hernia. With this technique, we can check for hernias on both sides, repair them if present, and limit the risk of future surgeries. Additionally, the minimally invasive nature of laparoscopic surgery results in less post-operative pain, quicker recovery, and minimal scarring, enhancing the quality of life for our young patients undergoing hernia repair.

Dr Nada’s shares a story about his patient

Inguinal Hernia Patient Testimonials

After having the key hole surgery, I could not believe how much improvement on my little baby boy. The result was almost instant. Following the operation, he had very little pain, just mild discomfort only. He was discharged from the hospital, on the same day of his operation. Small surgery scars were found and almost can’t be seen on his stomach. Now my little baby boy is doing well.

Shanti Raj Sue Yin – mother

“Thank you! Dr. Nada.” This is my wholehearted gratitude.

We rarely see the examples of newborn baby girl with inguinal hernia. Unfortunately, my two-months-old daughter is one of them.

On 24 of November 2014, I was surprised to discover the protrusion of my baby right groin after she cried. In the next morning, I contacted you via email and I was glad to receive your immediate response, and able to make an appointment with you to take a look on my daughter at hospital on the same afternoon.

From your professional analysis, my husband and I have a better understanding on the etiology and treatment of inguinal hernia. While we are aware that inguinal hernia cannot recover by self-healing and it is potentially to incarcerate at any time, which will cause organ necrosis and life-threatening. Thus, we have decided to let our baby underwent the laparoscopic surgery.

Waiting is always suffer. Fortunately, you able to schedule the operation for my daughter on 28 of November 2014 from your tight schedule. Within 2 weeks, my baby was recovered and her returned smiles is the best happiness and satisfaction to us.

Lastly, thanks for the recommendation from the feature writer, Mr. Ong Eng Leong, of Long Life Magazine. With that, my daughter was lucky to meet such a professional and caring doctor like you.

Yvonne Teh, mother

Conclusion: Provide Your Child With The Benefits of Keyhole Surgery

In summary, keyhole surgery for pediatric inguinal hernia presents a host of benefits over traditional open surgery. It’s less invasive, results in less scarring, offers quicker recovery, and allows for comprehensive inspection of the abdominal region. By adopting this method, surgeons can provide better care for their young patients and ensure peace of mind for their families.

Find out more HERE

If you require surgical help with your child, schedule an appointment with Dr Nada and put your mind at ease knowing that your child is in good hands.

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Dr Nada Sudhakaran

Paediatric Surgeon & Urologist

Paediatric Surgeon

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