MP26-06 NON-ABSORBABLE SUTURE IS ASSOCIATED WITH LOWER RECURRENCE RATES IN SUBCUTANEOUS ENDOSCOPICALLY ASSISTED LIGATION OF INGUINAL HERNIAS

Abstract

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2014MP26-06 NON-ABSORBABLE SUTURE IS ASSOCIATED WITH LOWER RECURRENCE RATES IN SUBCUTANEOUS ENDOSCOPICALLY ASSISTED LIGATION OF INGUINAL HERNIAS Melise Keays, Carlos Villanueva, Patricio Gargollo, Warren Snodgrass, Nicol C. Bush, and Micah Jacobs Melise KeaysMelise Keays More articles by this author , Carlos VillanuevaCarlos Villanueva More articles by this author , Patricio GargolloPatricio Gargollo More articles by this author , Warren SnodgrassWarren Snodgrass More articles by this author , Nicol C. BushNicol C. Bush More articles by this author , and Micah JacobsMicah Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.894AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Subcutaneous Endoscopically Assisted Ligation (SEAL) is a minimally invasive alternative to inguinal herniorrhaphy, with similar outcomes to open repair (≤4% recurrences). We describe SEAL in consecutive patients, emphasizing the impact of suture materials (absorbable vs non-absorbable) on recurrence rates. METHODS Prepubertal patients with symptomatic hernia or communicating hydroceles were included in the study. 4 pediatric urologists performed the operations using standardized technique: A 5mm laparoscope is inserted through the umbilicus to visualize the internal ring. A 2mm stab incision is done on the lateral border of the ring and spread with a fine hemostat. 2-0 suture on a CT-1 needle is passed preperitoneally around the internal ring under direct vision, on top of the spermatic vessels and the vas. 95% of the needle is brought out through the skin medial to the ring and then the back of the needle is passed under the skin out the initially stab incision. The suture is tied and if insufflation of the scrotum is still present, another suture is placed. Number of sutures placed to prevent insufflation, type of sutures, complications and recurrences were kept prospectively in a database. Patients that had bilateral hernia repair were analyzed as 2 individual repairs. SAS 9.2 was used for the analysis. RESULTS 97 repairs were performed (8 bilateral). Outcomes in 86 (89%) at a mean of 8 months are shown (Table). There were 11(23%) polyglactin versus 1(3%) polyester recurrences (p=0.005), at median time of 2.2 months. Multivariate analysis found the number of sutures used was not predictive of recurrence (p=0.9). CONCLUSIONS Contrary to previous reports, recurrence rates after SEAL are significantly lower in repairs performed with non-absorbable suture but not associated with the number of sutures placed. Based on this data, we recommend the use of non-absorbable suture during SEAL repair of inguinal hernias. Suture # of Repairs # Recurrences (%) Mean FU (months) 1 Suture Closure Mean Age (yrs) Mean Weight (kgs) Absorbable 47 11 (23%) 9.4 37 (79%) 4.6 19.2 Non-Absorbable 39 1 (3%) 5.5 24 (62%) 4.5 16.9 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e253 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Melise Keays More articles by this author Carlos Villanueva More articles by this author Patricio Gargollo More articles by this author Warren Snodgrass More articles by this author Nicol C. Bush More articles by this author Micah Jacobs More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...