الفهرس 
These ligaments delineate the next fossaeOnly 14 pages are availabe for public view
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Abstract
Inguinal hernia is one of the common disorders in childhood and has been documented to occur in 0.8-4.4% of the children. Incidence of pediatric inguinal hernia is the highest during the first year of life and gradually decreases thereafter. Premature infants have an even higher risk of developing inguinal hernia with reports with incidence up to 25%. Incidence of hernia is 6 times more in boys than girls. Hernias are more common on the right side. 60% occurring on the right side, 30% on left side and 10% are bilateral. Inguinal hernia repair is one of the most frequently performed surgical procedures in infants and young children. Treatment for this condition is high ligation of patent processus vaginalis at the level of the internal inguinal ring. This can be achieved either by conventional open method or by laparoscopic technique. Laparoscopic inguinal hernia repair has an established role in the management of this condition in children in trained hands. Indeed, it is fast becoming the gold standard for the treatment of inguinal hernia in children. The risk of injury to the vas deferens and cord structures in this procedure is lesser when compared to the conventional open technique. With increasing interest, there are various techniques in the laparoscopic repair of inguinal hernia in children. This proliferation has been orchestrated by refinements in methods of ligation of the patent processus vaginalis at the internal inguinal ring in order to improve results and the outcome of treatment. The various techniques are: extracorporeal or intracorporeal suturing and knotting, three or single port procedure, sac inversion and ligation technique in girls, flip-flap technique, and use of tissue adhesives. The objective of this study was to evaluate the outcome of laparoscopic repair of congenital inguinal hernia. This prospective study was conducted on 130 patients (with 158 hernia repair) presented with inguinal hernia who underwent laparoscopic hernia repair in Pediatric Surgery Unit, Surgery Department in Tanta University Hospital over a period of 2 years from Sep.2014 to Sept. 2016. Operation time, intra- and postoperative complications, postoperative stay, cosmesis, and the size of testis were recorded and compared for differences in the outcome. The study protocol was approved by the hospital ethical committee and parents signed a detailed informed consent. All children presented with inguinal hernia were included in the study except very low birth weight, major cardiac anomalies. Patients subdivided into; Unilateral cases(n=83): were subjected to disconnection of the hernial sac from the parietal peritoneum at the level of IIR followed by proximal closure of the peritoneum. There were no intraoperative complications and low recurrence rate. There was no incidence of clinical testicular atrophy. Recurrent cases(n=9): were subjected to disconnection of the hernia sac from the parietal peritoneum at the level of IIR, approximation of the transversalis arch with iliopubic tract followed by proximal closure of the peritoneum, there were no intraoperative complications, no post-operative recurrence and no incidence of clinical testicular atrophy. Bilateral cases(n=33):divided to two groups; TWO procedures done in the same patient; one side received intracorporeal purse string suture leaving the hernia sac intact (group I) The other side recevied disconnection of the hernia sac and closure of proximal peritoneum at intenal inguinal ring (group II). All operations were completed laparoscopically without conversion to open. There was statistically significant difference between the two groups regarding the operative time and hydrocele formation There was no significant statistical difference in the recurrence rate between the studied groups.