Optimizing the Working Space for Single-Port Laparoscopic Totally Extraperitoneal Closure of Inguinal Hernia with TPV Protocol in Infants and Young Children.

Abstract

Purpose: To evaluate the outcomes of single-port laparoscopic internal ring closure of inguinal hernia, optimized according to TPV (tilt, pad, and void) protocol, in infants and young children. Methods: From August 2018 to March 2021, a prospective cohort study was conducted including 400 patients younger than 3 years with either left- or right-side inguinal hernia treated with single-port laparoscopic totally extraperitoneal (TEP) closure of the internal ring using a two-hooked core needle apparatus. Patients whose hospitalization ID ended with an odd number were included in group A (n = 200). They were surgically treated with single-port laparoscopy optimized according to TPV protocol, in which the operating table was placed at a 30° head-down tilt position (tilt), the hip was padded by 4-5 cm (pad), and the bladder was voided (void). The remaining patients in group B (n = 200) were conventionally treated with single-port laparoscopic TEP closure of the internal ring. Success rate of surgery, surgery duration, and postoperative complications of two groups were compared. Results: A significantly higher success rate of surgery was detected in group A than in group B (198/200 versus 182/200, P < .05). Regardless of unilateral or bilateral inguinal hernia, surgery duration was significantly shorter in group A than in group B (unilateral inguinal hernia, 14.38 ± 2.85 minutes versus 21.17 ± 4.47 minutes; bilateral inguinal hernia, 20.73 ± 4.58 minutes versus 28.99 ± 4.12 minutes, both P < .05). In addition, the incidence of postoperative complications was significantly lower in group A (1/200 versus 8/200). Conclusions: TPV protocol to optimize working space for single-port laparoscopic TEP closure of inguinal hernia can increase the success rate, shorten surgery duration, and decrease the incidence of postoperative complications.