JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 24, Number 9, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2014.0153

Letter to the Editor

Two Decades of History of Laparoscopic Pediatric Inguinal Hernia Repair Ciro Esposito, MD, PhD, Maria Escolino, MD, Alessandra Farina, MD, and Alessandro Settimi, MD

Dear Editor:

W

e read with interest the article by Ostlie and Ponsky1 titled ‘‘Technical options of the laparoscopic pediatric inguinal hernia repair,’’ published in the March issue of the Journal. In our opinion, this article provided an excellent but not complete overview of popular laparoscopic pediatric hernia repair techniques. From a historical perspective, some of the earliest work and published studies of pediatric laparoscopic hernia repair were performed in the early 1990s by Philippe Montupet and colleagues. In particular, the first intracorporeal laparoscopic hernia repair was performed by Philippe Montupet in 1993. Montupet et al.2 published for the first time in a French journal, the Journal de Coeliochirurgie, on their first 3-year series (220 hernias) titled ‘‘Le traitement de la hernie inguinale conge´nitale chez l’enfant par coelioscopie: notes techniques.’’ Then Montupet published with co-workers two other articles on the same topic, in 1998 in Pediatric Surgery International3 and in 1999 in the Journal of Pediatric Surgery.4 As for the technique described by Montupet et al.2 (with the series beginning in 1993), the defect was closed performing a purse-string suture on the peri-orificial peritoneum at the level of internal inguinal ring with a nonabsorbable multifilament suture. Montupet and Esposito4 in 1999 modified and standardized the technique: the modification consisted in sectioning the peri-orificial peritoneum circumferentially, distally to the internal inguinal ring, before closing it with a purse-string suture. When the inguinal orifice is very large, >10 mm in diameter, a two-plane suturing technique can be used before closing the peri-orificial peritoneum. In order to reduce the diameter of the internal inguinal ring, one or two separate sutures can be positioned between the conjoined tendon and the crural arch.5 The opening of the peri-orificial peritoneum with the use of monopolar coagulation performed according to Montupet’s technique is a technical detail similar to the peritoneal injury created at the internal inguinal ring described by Ostlie and Ponsky1 in their current technique. We agree with the authors that this technical expedient does result in a more durable repair. In 1998, 5 years after the introduction of Montupet’s technique, Schier6 described the second most popular intracorporeal technique, consisting of a ‘‘N’’-shaped suture on

the peri-orificial peritoneum. Both techniques give similar results; in fact, a multicenter survey, including 933 repairs, published by Schier et al.7 in the Journal of Pediatric Surgery in 2002 (not reported in the references of Ostlie and Ponsky1) showed that these two techniques give similar results. With both techniques, Montupet’s and Schier’s, there was a success rate of 98%–99%.4,6 Montupet’s technique gives also excellent results in newborns with incarcerated inguinal hernia. As reported by Choi et al.8 and then by Esposito et al.,9 laparoscopic hernia repair in the newborn is feasible and safe and carries acceptable complication and recurrence rates. Another weak point of the article by Ostlie and Ponsky1 is about the description of the laparoscopic techniques in regard to direct hernia repair. As reported by Esposito et al.10 and Lima et al.,11 to perform direct hernia repair, first of all, it is important to resect the hernia lipoma (always present); then the surgeon has to close the hernia defect eventually with the aid of bladder lateral ligament to reinforce the suture. In conclusion, also, if the article by Ostlie and Ponsky1 describes accurately the most common laparoscopic techniques of pediatric inguinal hernia repair, we think that Montupet’s technique, which has been adopted by many pediatric surgeons in Europe, has to be described to the readers of this Journal and should be cited here among intracorporeal techniques for correction of pediatric inguinal hernia via laparoscopy. References

1. Ostlie DJ, Ponsky TA. Technical options of the laparoscopic pediatric inguinal hernia repair. J Laparoendosc Adv Surg Tech A 2014;24:194–198. 2. Montupet P, Esposito C, Roblot-Maigret B, De Petra MR. Le traitement de la hernie inguinale conge´nitale chez l’enfant par coelioscopie: Notes techniques. J Coeliochir 1996;26: 35–39. 3. Esposito C, Montupet P. Laparoscopic treatment of recurrent inguinal hernia in children. Pediatr Surg Int 1998;13: 182–184. 4. Montupet P, Esposito C. Laparoscopic treatment of congenital inguinal hernia in children. J Pediatr Surg 1999;34: 420–423. 5. Esposito C, Montinaro L, Alicchio F, Scermino S, Basile A, Armenise T, Settimi A. Technical standardization of

Department of Translational Medical Sciences, Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.

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LETTER TO THE EDITOR

laparoscopic herniorraphy in pediatric patients. World J Surg 2009;33:1846–1850. Schier F. Laparoscopic herniorrhaphy in girls. J Pediatr Surg 1998;33:1495–1497. Schier F, Montupet P, Esposito C. Laparoscopic inguinal herniorrhaphy in children: A three center experience with 933 repairs. J Pediatr Surg 2002;37:395–397. Choi W, Hall NJ, Garriboli M, Ron O, CurryJI, Cross K, Drake DP, Kiely EM, Eaton S, De Coppi P, Pierro A. Outcomes following laparoscopic inguinal hernia repair in infants compared with older children. Pediatr Surg Int 2012; 28:1165–1169. Esposito C, Turial S, Escolino M, Giurin I, Alicchio F, Enders J, Krause K, Settimi A, Schier F. Laparoscopic inguinal hernia repair in premature babies weighing 3 kg or less. Pediatr Surg Int 2012;28:989–992. Esposito C, Alicchio F, Giurin I, Castellano M, Settimi A. Technical standardization of laparoscopic direct hernia

repair in pediatric patients. J Laparoendosc Adv Surg Tech A 2012;22:113–116. 11. Lima M, Ruggeri G, Do`mini M, Lauro V, Libri M, Bertozzi M. Laparoscopic treatment of bilateral direct inguinal hernia by using the vesical ligament as an autologous patch. Pediatr Endosurg Innov Techn 2002;6:277–279.

Address correspondence to: Ciro Esposito, MD, PhD Pediatric Surgery Unit Federico II University of Naples Via Pansini 5 80131 Naples Italy E-mail: [email protected]

Two decades of history of laparoscopic pediatric inguinal hernia repair.

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