Laparoscopic Closure Research Articles

Primary Closure versus T Tube Drainage in Laparoscopic Common Bile Duct Exploration: Has the Paradigm Already Changed?

Purpose: The question of how to close de common bile duct (CBD) following of laparoscopic bile duct exploration (LCBDE) remains a topic of debate. Traditionally, the CBD is closed with T-tube drainage after choledochotomy and removal of CBD stones. With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills primary duct closure without a T-tube has been proposed as an alternative. In recent studies primary closure has been showing less complications, shorter hospitalization stay and reduced operative times discouraging the routine use of T-tube after LCBDE. The aim of this study is to compare the safety and effectiveness of primary closure with T-tube drainage in laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis. Method: Observational, retrospective study of patients undergoing LCBDE between January 2012 and May 2020. Descriptive and statistical analysis was performed with SPSS 25. Results: 71 patients underwent LCBDE with a transcholedochal approach (62% female, median age 67 years). Choledocoscopy was executed in 46.5% of the patients. Primary closure rate was 29.6%. The T-Tube group had a higher complications rate (24.5% vs 23.8%) and an inferior CBD stone clearance rate (87,8% vs 90.5%). The reintervention (7% vs 4.8%) and the hospital stay were superior in the T-tube group (7.6 vs 5.8 days). Conclusion: Primary closure was adopted as a preferred method in recent years in our hospital. Even with these previous results, we can assume that primary closure is feasible and associated with fewer complications, less need for reintervention and shorter hospital stay than T-tube drainage. Based on these results, primary duct closure may be considered as the optimal procedure for CBD closure after LCBDE.

The role of laparoscopic management in perforated gastric cancer.

PurposePerforated gastric cancer is an extremely rare condition and usually presents in advanced stage with poor prognosis. Surgical strategies are still controversial regarding the extent to which complete resection or primary repair is performed and the application of laparoscopic techniques. We aim to determine the role of laparoscopic 2-stage approach in perforated gastric cancer.MethodsAmong 2,318 gastric cancers in Yeouido St. Mary's Hospital from January 1990 to December 2017, 20 patients with perforated gastric cancer were enrolled, and 5 patients underwent 2-stage gastrectomy consisting of primary closure on perforation followed by curative gastrectomy. Clinicopathological features, surgical outcomes, and survival analysis were evaluated.ResultsTwo-stage approach for perforated gastric cancer was all performed by laparoscopic approach except 1 patient who needed paraaortic lymph node dissection (LND). Those were first treated on peritonitis with laparoscopic primary closure with or without Foley gastrostomy. Compared to 1-stage gastrectomy, more D2 LND was performed (60.0% vs. 100.0%, P = 0.260) and retrieved lymph nodes were significantly higher (median [range]: 17.0 [12.0–27.0] vs. 33.0 [26.5–43.5], P = 0.019]. Two patients of stage II and 3 patients of stage III were included in the 2-stage gastrectomy group. During the 38 months of median follow-up period, there were 8 and 1 recurrence among 1-stage and 2-stage gastrectomies, respectively. Except for 1 patient, 4 other 2-stage patients survived around 5 years without recurrence (5-year disease-free survival, 80%).ConclusionLaparoscopic 2-stage surgery for perforated gastric cancer is safe and might increase the curability of gastrectomy with extended LND.

Laparoscopic closure of an urinary bladder rupture in a Thoroughbred mare

Laparoscopic closure of an urinary bladder rupture in a Thoroughbred mare

Laparoscopic closure of the pouch of Douglas by a peritoneal running suture. A minimally invasive and prosthetic-free technique to prevent excessive dose delivery to the small bowel during pelvic irradiation for prostate cancer

Background and purposeProstate radiotherapy relies on the delivery of high doses that can be obstructed when a small bowel loop descends in the pelvis. We present a laparoscopic minimally invasive prosthetic-free technique closing the Douglas’ pouch with a peritoneal running suture to cordon off the bowel from the pelvis and hence allow optimal irradiation. Materials and methodsProstate cancer patients referred for radiotherapy and whose planning-CT revealed a bowel loop trapped in the pelvis were proposed the procedure, followed by a new planning-CT. This proof-of-concept study reports postoperative follow-up and dosimetric benefits. ResultsThe procedure was performed in ten patients (2016–2020) as a same-day surgery for nine. Median operative time was 34 min (range 22–50) and no relevant intraoperative complication occurred. The third patient of the series presented a small bowel hernia through the peritoneal suture at the 15th postoperative day requiring a laparotomic desincarceration without major consequences. Regarding the small bowel, median D1cc (dose to 1 cc) was 65.5 Gy and 55.5 Gy (p = 0.005) before and after procedure. Median V60 (volume receiving ≥60 Gy) was 10.2 cc and 0.0 cc (p = 0.005). In the immediate vicinity of the small bowel (5 mm), median D1cc was 68.3 Gy and 57.7 Gy (p = 0.005). Radiotherapy was safely delivered to all patients. ConclusionLaparoscopic closure of the Douglas’ pouch by a peritoneal suture is an efficient technique to cordon off inconvenient ectopic small bowel loops. It prevents excessive bowel irradiation and hence facilitates curative prostate radiotherapy. The technique could be applied to other pelvic malignancies.

Comparison of laparoscopic percutaneous extraperitoneal closure and laparoscopic intracorporeal suture in pediatric hernia repair

BackgroundLaparoscopic inguinal repair use is rapidly growing because it is a minimally invasive surgery (MIS) technique. However, there is insufficient evidence to support the use of one MIS over others. We compared laparoscopic intracorporeal suture (LIS) and laparoscopic percutaneous extraperitoneal closure (LPEC) to determine which technique is superior. MethodsBetween February 2017 and December 2019, 260 children who underwent LPEC and 214 children who underwent LIS were enrolled. Operative time, recovery score, and patient cosmetic satisfaction were compared. A total of 108 propensity score-matched pairs were analyzed using paired t-test for continuous measurements and McNemar test for categorical variables. ResultsThe mean surgery time was lower in the LPEC group for both unilateral (15.76 ± 5.35 vs. 19 ± 5.71 min; p = 0.04) and bilateral (21.56 ± 5.7 vs. 26.38 ± 6.94 min; p = 0.01) surgeries. The LPEC group required shorter time for complete recovery (p = 0.017). The mean rating for scar visibility was higher in the LIS group (p = 0.02); however, both groups had high levels of cosmetic satisfaction (p = 0.125). ConclusionLPEC for hernia repair is safe and efficient in children and reduced operative time, hastened recovery, and provided excellent cosmetic results.

Optimal Viewing Direction of the Oblique Laparoscope in Single-Incision Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia.

Background: It is difficult for novice surgeons to manipulate the oblique laparoscope in single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for inguinal hernia because of collisions between the instruments. To standardize manipulation of the laparoscope, we studied the viewing direction of the oblique laparoscope, and assessed the optimal manipulation of the laparoscope to avoid collisions. Methods: A retrospective chart review was performed on patients who underwent SILPEC between April 2016 and April 2017. The viewing direction of the 30° oblique laparoscope was measured according to the location of the field stop pointer. Patients were divided into three groups according to the viewing direction at the beginning of the procedure: the inside viewing direction was from -90° to -11°, upward viewing direction was from -10° to 10°, and outside viewing direction was from 11° to 90°. The length of the procedure, viewing direction at the end, and the percentage of cases in which there was a change in viewing direction during the procedure were compared. Results: Ninety-eight cases of SILPEC were performed during the study period. The percentage of patients with a change in category of viewing direction in the inside, upward, and outside groups was 35%, 21%, and 11%, respectively, showing a significant difference among the three groups. Conclusions: Setting the initial viewing direction to the outside can reduce correction of the viewing direction during SILPEC. Because the intersection angle between the outside-viewing laparoscope and forceps is close to a right angle, this might reduce collisions.

Laparoscopic repair of giant Morgagni hernia by direct suturing with V-Loc.

Morgagni hernias present technical challenges. The laparoscopic approach for repair was first described in 1992; however, as these hernias are uncommon in adult life, few data exist on the optimal method for surgical management. The purpose of this study was to analyze a method for laparoscopic repair of Morgagni giant hernias using laparoscopic primary closure with V lock (Medtronic, Covidien). This case series describes a method of laparoscopic Morgagni hernia repair using primary closure. In all patients, a laparoscopic transabdominal approach was used. The content of the hernia was reduced into the abdomen, and the diaphragmatic defect was closed with a running laparoscopic suture using a self-fixating suture. Clips were placed at the edges of the suture to secure the pledged sutures to both the anterior and posterior fascia. Demographic data such as BMI and operative and postoperative data were collected. Retrospectively collected data for 9 patients were analyzed. There were 1 (11.1%) males and 8 (88.8%) females. The median BMI was 29.14±52 kg/m2. The median operative time was 80±25 minutes. There were no intraoperative complications or conversions to open surgery. Patients began a fluid diet on the first postoperative day and were discharged after a median hospital stay of 3±1.87 days. In a median follow-up of 36 months, we did not observe any recurrences. Transabdominal laparoscopic approach with primary closure of the diaphragmatic defect is a viable approach for the repair of Morgagni hernia. In our experience, the use of laparoscopic transabdominal suture fixed to the fascia allowed the closure of the defect laparoscopically with minimal tension on the repairs.

Vaginal Cuff Closure Simulation: An Innovative Approach Using the FLS Lap Trainer

Study Objective Our objective was to describe a low-cost, easy-to-construct simulation model of laparoscopic vaginal cuff closure. Design Resident education simulation concept. Setting Simulation center. Patients or Participants OBGYN Residents. Interventions Modification of the FLS laparoscopic box trainer for simulation of vaginal cuff closure with two low-cost cuff models. Measurements and Main Results With the incorporation of the FLS assessment into the American Board of Obstetrics and Gynecology requirements, OBGYN residents have access to the standardized FLS laparoscopic box trainers. Our video demonstrated easy-to-construct modifications to the trainer box to optimize the simulation of proper port placement and provider positioning during a laparoscopic vaginal cuff closure. Rather than the traditional box trainers with the camera between the two ports, our modification used two ports placed lateral to the camera. We discuss two low-cost, reusable models - the Koozie and 3-Dmed Wet Vaginal Cuff. Both models replicate the inner vaginal mucosal layer and can be attached using the FLS box clip. We illustrated the steps of the vaginal cuff closure, highlighting key components and helpful tips on both of the simulation models. Demonstration of these models was depicted alongside intra-operative surgical footage. Residents can practice these skills on the two models in the modified FLS box trainer. Conclusion Residents can practice their surgical skills using the laparoscopic vaginal cuff closure simulation model and a modified FLS box trainer.

Complications Following Total Laparoscopic Hysterectomies: A Cohort Study Analyzing One Vs. Two-Layer Laparoscopic Vaginal Cuff Closure

Study Objective To determine whether two-layer laparoscopic vaginal cuff closure during laparoscopic hysterectomies is associated with lower postoperative complications compared to standard one-layer closure. Design Retrospective cohort study. Setting Academic tertiary care center. Patients or Participants 2,973 patients. Interventions During a 6-year period, 1760 (59.2%) and 1213 (40.8%) patients underwent single (1-LVC) vs. two-layer (2-LVC) laparoscopic vaginal cuff closure, respectively. Factors influencing laparoscopic vaginal cuff complications including age, postmenopausal status, body mass index, tobacco use, immunosuppressant medications, and sexual activity were recorded. We compared total postoperative complications including visceral injury, blood transfusion, hematoma, thromboembolism, infection, and cuff complications. The latter were further examined for cuff dehiscence, mucosal separation, hematoma, cellulitis/abscess, granulation tissue and persistent vaginal bleeding. Statistical analyses included Chi-square and Wilcoxon rank sum testing. Measurements and Main Results 2-LVC closure was associated with decreased total postoperative complications (2-LVC: 3.38% vs. 1-LVC: 5.57%; p=0.006) without impacting intraoperative complications (1.40% vs. 1.25%; p=0.721) or emergency room/hospital readmissions (11.05% vs. 12.67%; p=0.181). 2.44% of 1-LVC patients experienced postoperative cuff complications compared to only 0.74% women in the 2-LVC group (p=0.002). No subjects in the 2-LVC cohort experienced a vaginal cuff dehiscence or mucosal separation compare to 0.63% and 0.23% of patients in the 1-LVC group, respectively. Granulation tissue (1-LVC: 0.40% vs. 2-LVC: 0.16%), persistent vaginal bleeding (0.57% vs. 0.16%), and cuff cellulitis (0.51% vs. 0.33%) were also more common in the 1-LVC cohort. Univariate analysis of total postoperative cuff complications revealed that a 2-LVC closure was protective of postoperative complications (OR=0.37, 95% CI: 0.188-0.712). Conclusion Although postoperative problems linked to laparoscopic hysterectomies are already exceptionally low, the added use of a 2-LVC closure further lowers postoperative total and vaginal cuff complications.

High recurrence rate of children's inguinal hernia after percutaneous internal ring suturing: a single-center study.

To evaluate and compare the differences in recurrence rates of post inguinal hernia repair in children using Laparoscopic Intracorporeal Closure of the Processus Vaginalis (LICPV) and Percutaneous Internal Ring Closure (PIRS) operating techniques and compare them to published data. A retrospective data analysis of children who underwent LICPV or PIRS techniques between 2005 and 2018 in the tertiary paediatric surgery department of university hospital was done. We analyzed demographic data, operating time, the influence of surgeon, recurrence rate, and the time until recurrence within an observed period of time post-operatively. A total of 240 patients underwent laparoscopic inguinal hernia repair procedures between 2005 and 2018. Of them 138 (57.5%) were male and 102 (42.5%) were female, with mean age of 6.48 (SD ± 4.7). LICPV method accounted for 170 (70.8%) inguinal hernia repairs, whilst 70 (29.2%) underwent the PIRS procedure. The overall recurrence rate was 8.3%; it was significantly higher in the PIRS group (18.6% versus 4.11%, p < 0.05). Males presented higher recurrence rates over females across both procedures. The mean time taken for any recurrence to happen was shorter in patients who underwent the PIRS method as opposed to LICPV techniques, 3.3 and 6.5months, respectively (p > 0.05). In our hands, a significantly higher recurrence rate exists for children undergoing the PIRS method over LICPV techniques when treating inguinal hernias.

Trends and Risk Factors for Vaginal Cuff Dehiscence after Laparoscopic Hysterectomy

The primary objective was to assess the effect of the route of closure of the vaginal cuff on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy (LH). The secondary objective was to assess patient- and surgical-risk factors associated with VCD, rate of perioperative complications by route of closure, and impact of surgeon volume on complications. Retrospective chart review with case-control component. Tertiary care center (main hospital and regional hospitals). A total of 1278 women underwent LH or robot-assisted hysterectomy in 2016, and met the inclusion criteria. Independently, 26 cases of VCD were identified from 2009 through 2016. A retrospective comparison of patients with vaginal cuff closure and laparoscopic cuff closure (LCC) undergoing LH or robot-assisted hysterectomy in 2016. Patients with VCD from 2009 through 2016 (n = 26) were matched by route of cuff closure to the next 7 patients who underwent hysterectomies (n = 182), who became controls. In 2016, there were 9 cases of VCD (0.70%). There was no significant difference in VCD between LCC (8/989; 0.81%) and vaginal cuff closure (1/289; 0.35%; p = .41). Seven VCD cases were performed by high-volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture. There were no significant differences in the rates of perioperative complications or surgeon volume between routes of cuff closure. The case-control patients differed in smoking status (p = .010) and history of prior laparotomy (p = .017). Logistic regression showed that increasing age (odds ratio 0.95; 95% confidence interval, 0.91-0.99) and increasing body mass index (odds ratio 0.98; 95% confidence interval, 0.83-0.97) were protective for VCD. VCD is a rare but serious complication of LH. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend that, to optimize patient outcomes, surgeons employ the closure technique that they are best accustomed to.

Can Intraoperative Video Recordings Contribute to Improving Laparoscopic Percutaneous Extraperitoneal Closure in Children with Inguinal Hernia and Prevent Recurrence? A Pilot Study.

Aim: We reviewed intraoperative video recordings (IVRs) of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia in children blindly to assess performance. Methods: IVRs of 183 LPEC performed between April 2013 and March 2016, graded by the operating surgeon as difficult (D; n = 8), straightforward (S; n = 96), or easy (E; n = 79), were scored by a panel of reviewers with advanced (group A; >400 LPEC cases; n = 5), intermediate (group I; 50-150 cases; n = 5), and basic (group B; <10 cases; n = 5) experience, according to suturing, dissection plane, vas/vessel dissection, bleeding, and peritoneal injury. They also allocated a recurrence risk rank (RRR; highest = 6; lowest = 1) for each IVR. Mean score variance for each IVR was also compared between reviewers. Results: There was one recurrence (R; 4-year-old male; level E). RRR were: 1, 2, and 2 for reviewers A, I, and B, respectively. Reviewer A scores for "suturing" and "bleeding," and reviewer I scores for "dissection plane" and "peritoneal injury" correlated significantly with RRR. No reviewer B scores correlated with RRR. Score variance between A and I and A and B for cases D1 and D2 were statistically significant. Conclusion: Advanced reviewers showed greatest variance, questioning the validity of whether experience alone improves surgical technique.

腹腔鏡下鼠径ヘルニア根治術（LPEC）を契機に診断された性分化疾患（DSD）の3例

腹腔鏡下鼠径ヘルニア根治術（LPEC）を契機に診断された性分化疾患（DSD）の3例

Laparoscopy-Assisted Transscrotal Orchidopexy for Palpable Undescended Testis: Initial Results

Background: Undescended testis (UDT) is one of the most common congenital genital malformations in boys. However, orchidopexy carries a risk of injuring the testicular vessels and vas deferens. We therefore developed a novel approach to manage palpable UDT. Materials and Methods: We analyzed the medical records of patients who underwent orchidopexy at our institute between January 2017 and April 2020. This study was approved by the Institutional Review Board of our hospital. The age, body weight, laterality, testicular position, length of operation, and complications were investigated. The patients were classified into two groups depending on the surgery received: laparoscopy-assisted transscrotal orchidopexy (LATO) or conventional inguinal orchidopexy (CO). In brief, LATO involves preceding laparoscopic closure of the patent processus vaginalis (PPV) followed by transscrotal orchidopexy. Dissection of the PPV from the testicular vessels and vas deferens was minimized through this procedure. The chi-squared test and t-test were used to analyze the significance of the data. Results: Among a total of 49 patients, 24 (33 testes) underwent LATO, and 25 (30 testes) underwent CO. There was no significant difference in patients' age, body weight, or laterality. The length of operation was similar between the groups in both unilateral and bilateral cases. The contralateral PPV was confirmed in 80% of unilateral cases of LATO (12/15). No complications, including testicular atrophy and postoperative ascent, were noted in either group. Conclusions: There were no significant differences between the groups in the surgical results. However, the confirmation and ligation of the PPV were easier in LATO, and peeling of the testicular vessels and vas deferens was minimized. LATO may be safe and effective for managing palpable UDT.

Laparoscopic Abdominoscrortal Hydrocele: A Case Series

ObjectiveTo evaluate the effect of laparoscopic percutaneous extraperitoneal closure (LPEC) of the internal inguinal ring for the treatment in pediatric abdominoscrotal hydrocele (ASH) and to assess the feasibility and safety of the procedures. Patients and MethodsData were collected from the charts of patients with ASH who underwent surgery in Kokura Medical Center from April 2014 to December 2019. The patients’ characteristics, preoperative diagnosis, forms of abdominal components, presence of patent processus vaginalis (PPV), associated pathologies, and postoperative results were evaluated. ResultsThe study population included 10 patients (4.3% of all 230 hydroceles). The mean age of 10 patients was 3.5 years (range, 7 months to 7 years). A preoperative diagnosis of ASH was made in 3 patients. In the other 7 patients, ASH was detected during laparoscopic repair of the scrotal hydrocele. The abdominal forms of hydrocele were monolocular cysts (n = 6) and multilocular cysts (n = 4). PPV was detected by laparoscopy in all cases. Six patients had contralateral pathologies, including PPV (n = 4), inguinal hernia (n = 1), and scrotal hydrocele (n = 1). One patient had ipsilateral undescended testis. Preoperative ultrasonography showed some degree of testicular dysmorphism on the affected side in 4 cases. In all cases, treatment was accomplished by closing the PPV at the internal inguinal ring by LPEC procedures. No patients had postoperative complications, including recurrent ASH or hydrocele after ASH repair (mean follow-up, 2.6 years). ConclusionLPEC may be an adequate and minimally invasive method for the treatment of the pediatric ASH.

The use of biosynthetic mesh in giant hiatal hernia repair: is there a rationale? A 3-year single-center experience.

Reinforced prosthetic crural repair is particularly indicated for giant hiatal hernias. The rationale is to reduce the recurrence rate in the long term. The aim of our study is to evaluate the outcomes of laparoscopic giant hiatal hernia repair using a biosynthetic mesh. We retrospectively analyzed 44 patients who underwent laparoscopic mesh-reinforced hiatal closure and fundoplication using a biosynthetic material. Inclusion criterion was large hiatal defects (> 5cm). Follow-up was scheduled at 6, 12 and 36months after surgery. 44 patients (29F) with a mean age of 62years (range 14-85) and mean of BMI 24.5kg/m2 (range 21-29) underwent successful laparoscopic repair. Twenty-six (59.1%) patients had Nissen-Rossetti fundoplication, whereas 18 (40.9%) had Toupet fundoplication. Six-month questionnaire for the evaluation of symptoms was available for 43 patients (97.7%) and for 40 (90.9%) patients at 12 and 36months. Mean preoperative symptoms score analysis was 1.68 ± 0.73. Mean scores at each follow-up time were significantly improved compared to baseline (p > 0.05). Barium swallow was available in 37 patients (84.1%) at 1year after surgery. Radiologic recurrence was observed in two patients (4.5%). No patient had symptoms attributable to recurrence or required revisional surgery. There were no mesh-related complications at 3years follow-up. The use of biosynthetic mesh for crural reinforcement is associated with a low incidence of mesh-related complications and with a reasonably low recurrence rate (4.5%) at 36months. However, additional data with longer follow-up are needed to determine long-term safety and efficacy.

Single-port laparoscopic percutaneous extraperitoneal closure for inguinal hernias repair in girls: using an epidural needle assisted by a towel forceps

BackgroundThe concept of single-port laparoscopic percutaneous extraperitoneal closure for the treatment of inguinal hernias repair in children has been practising recent years. The applicable instruments and skills are still evolving. In this study, we used an epidural needle assisted by a towel forceps to practise this minimal invasive method for inguinal hernias repair in girls. Its safety and effectiveness were studied.MethodsFrom July 2008 to January 2020, thirty-five girls diagnosed of indirect inguinal hernias were studied retrospectively. From April 2017 to January 2020, the author was free to propose open or laparoscopic repair for the patients. The open group included twenty-four girls and the laparoscopic group included eleven. The data of the patients age, constituent ratios of sliding and bilateral hernias, operating time, postoperative time in hospital, follow-up time, conversion, postoperative complications were assessed.ResultsThere were no statistically significant difference between the laparoscopic group and open group for the following items: age, operating time, postoperative time in hospital, the constituent ratios of sliding hernia and bilateral hernias (P > 0.05). The follow-up time of the open group was longer than that of the laparoscopic group (P = 0.0004). One laparoscopic case was converted to open surgery. After 12 cases of laparoscopic practice, coordination of the hand and eye movements established well. There were no postoperative complications for all the patients.ConclusionOur preliminary experience suggested that it is safe and convenient for inguinal hernias repair in girls by the single-port laparoscopic percutaneous extraperitoneal closure method using an epidural needle assisted by a towel forceps.

Effectiveness of a paraverterbral nerve block versus local portal blocks for laparoscopic closure of the nephrosplenic space: A pilot study.

To compare the effectiveness of a paravertebral nerve block vs local portal blocks for laparoscopic closure of the nephrosplenic space in standing sedated research horses. Randomized clinical trial. Twelve horses were randomly allocated to two groups (n = 6 per group), paravertebral block of nerves T18 , L1 , and L2 or local blocks of the three laparoscopic portals. Horses were sedated with dexmedetomidine (4 μg/kg IV and constant rate infusion [CRI] of 2.5 μg/kg/h) and morphine (50 μg/kg IV and CRI of 30 μg/kg/h). According to group allocation, 20 mL of either lidocaine or saline was injected into each paravertebral nerve site or into each local portal site to facilitate laparoscopy for closure of the nephrosplenic space. The overall quality of sedation, analgesia, behavior exhibited during surgery, and ease to perform the surgery were blindly scored by using a visual analog scale (VAS). Time to complete local anesthesia was similar for both blocks, and there was no difference in VAS scores between groups. Total duration of surgery was also similar between the paravertebral (79 ± 16 min) and local portal blocks (85 ± 25 min) groups. The paravertebral nerve block and the local portal blocks provided similar conditions during surgery and can be used interchangeably for closure of the nephrosplenic space. The paravertebral nerve block can be readily performed and may be useful in surgical procedures.

Single-port laparoscopic percutaneous closure of the internal ring for scarless repair of inguinal hernias in girls

Purpose The purpose of this study was to summarize the clinical experience with laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle for inguinal hernias in girls. Material and methods A total of 462 girls with inguinal hernias participated in this study from January 2013 to June 2019. Laparoscopic percutaneous extraperitoneal closure of the internal ring via an epidural needle was used to treat these patients. Results All 462 girls with an inguinal hernia successfully underwent laparoscopic surgery. The operative times for unilateral and bilateral inguinal hernias were 15 (11–25) minutes and 23 (18–33) minutes, respectively. All patients were discharged 1–2 days after the operations. During the hospitalization and follow-up periods, none of the following complications were observed: hernia recurrence, umbilical hernia, abdominal wall vascular injury, intestinal injury or bladder injury. However, there were six patients with complications: two cases of poor healing of the umbilical incision, three cases of suture granulomas and one case of groin traction pain and discomfort. Conclusion Laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle is a safe and feasible method for the treatment of inguinal hernias in girls. This method has the advantages of limited trauma, no scarring and a good cosmetic effect.

Laparoscopic assisted anterior transabdominal wall closure using loop suture removing technique in Morgagni hernia: safe and easy method.

The treatment of MHentailssurgical repair either by open abdominal or thoracic approaches or by minimal invasive surgery. The aim of this study is to evaluate the surgical and clinical outcomes of children who underwent laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique. This retrospective study includes pediatric patients who underwent surgery for MH betweenJanuary 2015 and February 2019. The patients' demographic data, symptoms, operative findings and technique and postoperative outcomes were recorded. A total of 17 children with MH were treated. There were 13 boys (76.5%) and four (23.5%) girls. Six patients had trisomy 21 (37%). The mean operation time was40min (25-90min). The hernia sac was removed in all patients and there was no need for prosthetic patch in any of the children. Mean time to start feeding was 10h (6-24h). The mean hospitalization time was 2days (1-5days). There were no complications intraoperatively or postoperatively. The mean follow-up time was 24months (6-40). No recurrence occurred during the follow-up time. Laparoscopic assisted transabdominal wall closure and subcutaneous knot placement technique is a preferable method with excellent outcomes and short hospitalization and feeding time postoperatively. This technique may be performed easily and safely without requiring any additional experience other than basic laparoscopy skills.