Laparoscopic Herniorrhaphy Research Articles

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty.

The totally preperitoneal (TPP) approach is a new concept that was recently introduced. Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages, there is little evidence reflecting the characteristics and feasibility of either approach. To analyze the potential applications of single-incision laparoscopic TPP (SIL-TPP) inguinal hernia hernioplasty for the treatment of inguinal hernias. A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022. A single-port, named Iconport, and standard laparoscopic instruments were used during the operation. Demographic data, intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed. The demographic data of 152 patients underwent SIL-TPP were shown in Table 1. The average age was 49.5 years (range from 21 to 81 years). The average body mass index was 27.7 kg/m2 (range from 17.7 kg/m2 to 35.6 kg/m2). SIL-TPP were conducted successfully in 147 patients. Three patients were converted to the SIL-transabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience. In 2 patients with incisional hernias, an auxiliary operation hole was added during the SIL-TPP procedure, as required for surgery. The mean operative time was 64.5 minutes (range: 36.0-110.0 minutes) for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias (range: 40.0-150.0 minutes). The mean postoperative hospital stay was 3.4 days. SIL-TPP is feasible and has advantages for inguinal hernia repair. SIL-TPP has potential benefits for patients with various abdominal wall hernias. Consequently, doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

An unusual case of an isolated, incarcerated appendix epiploica inguinal hernia and laparoscopic mesh herniorrhaphy

Abstract An isolated appendix epiploica (AE) inguinal hernia remains a rare surgical entity despite laparoscopic herniorrhaphy and improved intra peritoneal visualization. The surgical disposition of the AE remains controversial with proponents for both excision and conservative management. The paucity of data, based only on case reports precludes definite guidelines in their management. The presence of infection, organ ischemia, surgeon experience, and biological mesh availability all play a role in the management of this type of hernia. We present a rare case report with a viable incarcerated, AE inguinal hernia and its laparoscopic excision, and hernia repair. This is only the third such case report in the published literature to date.

A case of indirect inguinal bladder hernia treated with laparoscopic transabdominal preperitoneal repair with high peritoneal incisional approach

BackgroundInguinal herniation of the urinary bladder is uncommon and those descending into the scrotum are even rarer. Although open anterior repair has been used for inguinal bladder hernia, the efficacy of laparoscopic herniorrhaphy has been reported in recent years.Case presentationA 63-year-old man presented with an irreducible right groin and scrotal bulge associated with voiding difficulty. Abdominal ultrasonography showed a dislocation of the urinary bladder descending into the right scrotum. Abdominal CT imaging revealed that a part of the bladder and small intestine was herniating into the scrotum through the internal inguinal ring and running laterally to the inferior epigastric artery. Under the diagnosis of indirect inguinal bladder hernia, the patient underwent trans-abdominal preperitoneal hernia repair (TAPP). The bladder herniated into the scrotum through the internal inguinal ring was replaced to the original position. Then the myopectineal orifice was exposed and covered with polypropylene mesh, where a horizontal peritoneal incision 4 cm above the hernia orifice, i.e., the high peritoneal incision approach (HPIA), allowed an easy peeling of the peritoneum and hernia sac. The patient’s postoperative course was uneventful and the voiding difficulty resolved. The patient continued to do well without recurrence at 20 months after surgery.ConclusionPreoperative evaluation with abdominal ultrasonography and CT scan allowed a precise diagnosis of a groin hernia with voiding difficulty. TAPP with HPIA was useful in the treatment of inguinal bladder hernia because this technique facilitated a quick confirmation of the hernia contents, secure dissection of the whole protruded bladder, and adequate replacement of the bladder to the original position without any injury.

Safety and efficacy revisited: a systematic review and meta-analysis of glue versus tack mesh fixation in laparoscopic inguinal herniorrhaphy.

This analysis addresses the uncertainty surrounding the efficacy of glue mesh fixation (GMF) compared with tack mesh fixation (TMF) in laparoscopic herniorrhaphy. Our meta-analysis incorporates recently conducted randomized controlled trials (RCTs) to enhance the reference for assessing the efficacy and safety of GMF. PubMed Central, Google Scholar, Science Direct, and Cochrane Library were extensively reviewed for articles in the English language performed from inception to May 2023 using the keywords "Glue mesh repair," "Tack mesh repair," "Inguinal Hernia," "Herniorrhaphy," "Laparoscopic," "Mesh Fixation," and "Randomized controlled trials." In this meta-analysis, we incorporated a total of 20 randomized controlled trials, evaluating each article individually using quality ratings. Compared with TMF, GMF demonstrated a significant reduction in the incidence of chronic pain [RR: 0.40, (0.23, 0.68)] and pain scores on postoperative day 1 [MD: -1.07, (-1.90, -0.25)]. We also used funnel plots and Egger's regression to test for publication bias. In summary, this meta-analysis establishes the significance of GMF in reducing chronic pain and postoperative day 1 pain compared with TMF. However, no statistically significant difference was noted between the GMF and TMF groups concerning hematoma, seroma, operation time, recurrence rate, and total complications. Nonetheless, given the small number of cases in this study, the findings must be validated in the future by multicenter, large-sample, high-quality RCTs.

To use a simple hernia needle for single-port laparoscopic percutaneous inguinal hernia repair in children: a 5-year experience study.

The aim of this study is to investigate the technique and practical significance of using a simple hernia needle in single-port laparoscopic herniorrhaphy in pediatric patients. The study conducted a retrospective analysis of all pediatric patients who underwent treatment for inguinal hernia using single-port laparoscopic herniorrhaphy with a simple hernia needle at Yellow River Sanmenxia Hospital from June 2018 to May 2023. The medical records of all the children were collected, and clinical characteristics, procedural information, and follow-up data were carefully reviewed. A total of 848 patients underwent inguinal hernia repair, with ages ranging from 7 months to 13 years (2.99 ± 2.49 years), including 756 males and 92 females. A total of 528 cases of unilateral hernia and 310 cases of bilateral hernia were reported, with intra-operative findings revealing contralateral occult hernia in 253 cases. Single-port laparoscopic herniorrhaphy was successfully completed in all patients, with no instances of conversion to open surgery. The mean operation time for unilateral hernia repair was (7.50 ± 4.80) min, while for bilateral hernia repair it was (11.55 ± 7.27) min. Five patients presented with subcutaneous emphysema, while two patients experienced a recurrence of inguinal hernia. No complications, such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, were observed. The duration of the follow-up period ranged from 3 to 24 months. The promotion and utilization of single-port laparoscopy combined with a simple hernia needle in clinical practice are justified. Our initial investigation indicates that this surgical approach is both safe and dependable for the management of pediatric inguinal hernia. The procedure presents numerous benefits, including the utilization of uncomplicated instruments, straightforward operation, a clear curative impact, minimal tissue damage, rapid recovery, and the absence of scarring.

Minimally invasive repair of congenital inguinal hernias in nine foals using an automated laparoscopic suturing device and barbed suture

SummaryBackgroundLaparoscopic herniorrhaphy using staples or smooth suture has been shown to be safe and effective for the surgical treatment of congenital inguinal hernia in colts and gives the possibility to spare the testicles. An automated laparoscopic suturing device combined with barbed suture reduces the technical challenges of laparoscopic suturing.ObjectivesThe objective of the study was to describe the application of the Endo Stitch™ automated suturing device in combination with V‐Loc™ unidirectional barbed suture for laparoscopic herniorrhaphy in foals with congenital inguinal hernia, share experiences and provide long‐term follow‐up regarding the outcome.Study designRetrospective case series.MethodsMedical records of all foals that had laparoscopic herniorrhaphy using the Endo Stitch™ combined with V‐Loc™ unidirectional barbed suture at two equine referral hospitals between May 2015 and July 2022 were reviewed. Long‐term follow‐up was conducted by telephone interviews with the owners using a standardised questionnaire.ResultsNine foals aged 0.5–13 weeks suffering from unilateral (seven cases) or bilateral (two cases) indirect inguinal hernia underwent unilateral (two cases) or bilateral (seven cases) laparoscopic herniorrhaphy using the described technique. In two animals, the testicles were spared, five animals were bilaterally castrated, and two were unilaterally castrated at the time of herniorrhaphy. No major intraoperative complications occurred. Postoperatively, foals were bright and alert and none of them had significant complications attributable to the surgery. Median long‐term follow‐up was 8 months. No re‐herniation was observed in any of the cases at any time postoperatively.Main limitationsRetrospective study design and follow‐up period of less than 6 months in three cases.ConclusionsLaparoscopic herniorrhaphy using the Endo Stitch™ laparoscopic suturing device and V‐Loc™ barbed suture is technically less demanding than previously described laparoscopic techniques and effective in preventing re‐herniation in foals suffering from congenital inguinal hernia. A fast and uncomplicated postoperative recovery can be expected.

Are we following guidelines in inguinal hernia repair? An evaluation of practice patterns in the abdominal core health quality collaborative

Aim : The HerniaSurge Group established inguinal hernia repair guidelines to reduce recurrence and chronic pain. We evaluated whether the surgeons of the Abdominal Core Health Quality Collaborative (ACHQC) follow these guidelines and identify areas for improvement. Methods : A retrospective evaluation of data from the ACHQC database between 2013-2021 using 18,641 eligible subjects undergoing elective and emergent hernia repair with 30-day follow-up. Compliance with a given guideline was defined as following the recommendation in 70% of cases. Results : Twelve of 19 questions with available data met recommendations based on our above criteria. Eight recommendations with strong evidence and four recommendations with weak evidence were met. The recommendations not met were using the Shouldice technique for any non-mesh open inguinal herniorrhaphy, using local anesthesia for open repair of reducible inguinal hernias, using lightweight mesh, and avoiding the use of prophylactic antibiotics in laparoscopic herniorrhaphy. Conclusion : Despite varied techniques for inguinal hernia repair, surgeons of the ACHQC follow the majority of the recently published guidelines on the subject. While further research is needed to strengthen the existing guidelines, a standardized approach will facilitate this effort while aiming to reduce negative patient outcomes.

Laparoscopic interventions in pediatric short-stay surgical units

Introduction. One-day surgery in pediatrics is the most preferred form of elective surgical care for children. However, today issues of laparoscopic surgical interventions in children in a one-day hospital unit remain debatable, since these interventions often require tracheal intubation which increases risks of anesthetic complications at early postoperative period.Material and methods. From 2017 to 2021, 2401 laparoscopic interventions were performed on patients with varicocele, inguinal hernia and non-palpable testicular syndrome in the short-stay department of Morozovskaya Children’s City Clinical Hospital. Average age of patients was 7 years (range 1–18 years). 910 laparoscopic herniorrhaphies, 1412 laparoscopic testicular vein ligations and 79 diagnostic laparoscopies were performed. The department has developed a unique algorithm of anesthesia for laparoscopic surgeries in children in a short-stay unit.Results. There were no anesthesia-related complications or other intraoperative complications. Restoration of independent motor activity in patients is registered in 1.5–2 hours after surgery. Average length of stay in the department is 7.1 hours (6–8 hours).Conclusion. Thus, currently, modern high-tech laparoscopic surgeries are carried out in short-stay surgical departments, while previously they were performed only in round-clock surgical departments. The researchers could achieve such successful results because of an original algorithm of safe anesthesia which has been developed in the department. This anesthetic support is highly effective for laparoscopic interventions in children with elective surgical pathologies in a short-stay hospital.

Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea.

Background and Objectives: Inguinal hernia is a common surgical disease. Traditional open herniorrhaphy has been replaced by laparoscopic herniorrhaphy. Nowadays, many attempts at robotic herniorrhaphy have been reported in western countries, but there have been no reports in South Korea. The purpose of this study is to report our initial experience with robotic inguinal hernia surgery, compared to laparoscopic inguinal hernia surgery. Materials and Methods: We analyzed the clinical data from 100 patients who received inguinal hernia surgery in our hospital from November 2020 to June 2022. Fifty patients underwent laparoscopic surgery, and 50 patients underwent robotic surgery using the da Vinci Xi system. All hernia surgeries were performed by a single surgeon using the transabdominal preperitoneal (TAPP) method. Results: The mean operation time and hospital stay were not statistically different. On the first postoperative day, the visual analog scale (VAS) pain score was significantly lower in the robotic surgery group (2.9 ± 0.5 versus 2.5 ± 0.7, p = 0.015). Cumulative sum analysis revealed an approximately 12-case learning curve for robotic-assisted TAPP hernia surgery. Conclusions: Robotic-assisted TAPP inguinal hernia surgery is technically acceptable to surgeons who have performed laparoscopic inguinal hernia surgery, and the learning curve is relatively short. It is thought to be a good step toward learning other robot-assisted operations.

Comparing Outcomes of Single-Incision Laparoscopic Herniorrhaphy in Newborns and Infants.

As surgical techniques progress, laparoscopic herniorrhaphy is now performed more often in premature babies. The aim of this study was to analyze the outcomes of newborns and infants who underwent single-incision laparoscopic herniorrhaphy (SILH) at our center. We retrospectively reviewed patients younger than 12 months old who received SILH at our department from 2016 to 2020. SILH involved a 5 mm 30-degree scope and 3 mm instruments with a 3-0 Silk purse-string intracorporeal suture for closure of the internal ring. At the time of surgery, Group 1 newborns, whose corrected age was 2 months and below, were compared to the Group 2 infants, whose age was above 2 months. We assessed the patients' characteristics, anesthesia, surgical data, and complications. A total of 197 patients were included (114 newborns in Group 1 and 83 infants in Group 2). The mean age and body weight in Group 1 were 1.2 months and 3.8 kg, respectively, whereas in Group 2, they were 3.2 months and 6.7 kg, respectively. There were no significant differences in operative time (Group 1 = 34.1 min vs. Group 2 = 32.3 min, p = 0.26), anesthetic time (Group 1 = 80.0 min vs. Group 2 = 76.3 min, p = 0.07), length of hospitalization (Group 1 = 2.3 days vs. Group 2 = 2.4 days, p = 0.88), postoperative complications including omphalitis (Group 1 = 5.3% vs. Group 2 = 1.2%, p = 0.13), wound infection (Group 1 = 0.9% vs. Group 2 = 1.2%, p = 0.81), and hydrocele (Group 1 = 0.35% vs. Group 2 = 8.4%, p = 0.14). No recurrence, testicular ascent or atrophy, or mortality was observed in either group during the 2-year follow-up period. Single-incision laparoscopic herniorrhaphy is a safe and effective operation for inguinal hernia repair in infants, even those with prematurity, lower body weight at the time of surgery, or cardiac and/or pulmonary comorbidities. Comparable results revealed no significant differences in perioperative complications despite younger ages and lower body weights.

An Inguinal Endometriosis without Any Other Pelvic Endometriosis Mimicking Direct Inguinal Hernia: A Case Report

Inguinal endometriosis is a rare disease. Patients with inguinal endometriosis usually exhibit cyclic inguinal pain with a cyclic change in the size of the inguinal mass. It is more often found on the right side and commonly accompanies concomitant endometriosis lesions on pelvic organs or peritoneum. We report a case of inguinal endometriosis without any of the usual characteristics. A 48-year-old with non-severe dysmenorrhea and pelvic pain presented a left inguinal mass, palpable only when standing. Under the impression of direct inguinal hernia, laparoscopic herniorrhaphy was performed. Intraoperative laparoscopic findings revealed no other endometriosis lesion on the pelvic organ or in the abdominal cavity, and the histopathologic report confirmed it was endometriosis. Thorough inspection and excision of endometriosis lesions in the pelvic cavity are crucial for treatment. Therefore, an appropriate surgical plan following accurate preoperative diagnosis is important. If the intraoperative evaluation of endometriosis was not enough, postoperative gynecologic assessment is strongly recommended.

Abdominal Wall Block Decreases Intraoperative Opioid Con-Sumption by Surgical Pleth Index-Guided Remifentanil Administration in Single-Port Laparoscopic Herniorrhaphy: A Prospective Randomized Controlled Trial

Abdominal wall blocks (AWBs) can reduce pain during surgery and lessen opioid demand. Since it is difficult to know the exact level of intraoperative pain, it is not known how much the opioid dose should be reduced. In this study, using the surgical pleth index (SPI), which indicates pain index from sympathetic fibers, the amount of remifentanil consumption was investigated. We conducted single-port laparoscopic hernia repair in 64 patients, as follows: the regional block group (R group) was treated with AWB, while the control group (C group) was only subjected to general anesthesia. In both groups, the remifentanil concentration was adjusted to maintain the SPI score between 30 and 40 during surgery. The primary parameter was the amount of remifentanil. A total of 52 patients completed the study (24 in the R group, 28 in the C group). The remifentanil dose during surgery was decreased in the R group (29 ± 21 vs. 56 ± 36 ng/kg/min; p = 0.002). Visual analogue scale score and additional administrated analgesics were also low in the R group. As such, AWB can reduce the remifentanil dose while maintaining the same pain level.

Effects of deep neuromuscular block on surgical pleth index-guided remifentanil administration in laparoscopic herniorrhaphy: a prospective randomized trial

Deep neuromuscular block (NMB) has been increasingly utilized, but its role in reducing intraoperative opioid requirement has yet to be investigated. Surgical pleth index (SPI) quantifies nociception. We investigated the effects of deep NMB on SPI-guided remifentanil administration in laparoscopic herniorrhaphy. Total 128 patients undergoing laparoscopic inguinal herniorrhaphy were randomly allocated to two groups of NMB: deep (n = 64) and moderate (n = 64). The remifentanil dose was assessed during intubation, from skin incision until CO2 insertion, and pneumoperitoneum. Mean infusion rate of remifentanil during pneumoperitoneum was higher in moderate NMB group than in deep NMB group (0.103 [0.075–0.143] µg/kg/min vs. 0.073 [0.056–0.097] µg/kg/min, p < 0.001). Consequently, median infusion rate of remifentanil during anesthesia was higher in moderate NMB group (0.076 [0.096–0.067] µg/kg/min vs. 0.067 [0.084–0.058] µg/kg/min, p = 0.016). The duration of post-anesthesia care unit stay was longer in the moderate NMB group (40 [30–40] min vs. 30 [30–40] min, p = 0.045). In conclusion, deep NMB reduced the remifentanil requirement compared with moderate NMB in SPI-guided anesthesia for laparoscopic herniorrhaphy.

Single-port laparoscopic percutaneous extraperitoneal internal ring closure for paediatric inguinal hernia using a needle grasper.

Single-site laparoscopic percutaneous extraperitoneal closure has been widely used for the repair of paediatric inguinal hernia. In this study, we aimed to introduce the usage of a needle grasper in single-port laparoscopic herniorrhaphy in children. In our study, 447 children with inguinal hernia underwent single-port laparoscopic percutaneous extraperitoneal closure between October 2018 and October 2021 in Shenzhen Children' hospital were retrospectively reviewed. Among 447 patients, there were 396 males and 51 females with a mean age of 2.24 ± 0.36years. A contralateral patent processus vaginalis was present in 165 unilateral hernia patients. All patients underwent laparoscopic percutaneous extraperitoneal closure successfully without converting to open operation. The mean operating time in unilateral and bilateral hernia patients were 10.23 ± 2.25 mine and 14.54 ± 2.81 mine respectively. One patient had subcutaneous emphysema, two male patients had inguinal hernia recurrence and none had complications such as hydrocele and testicular atrophy. Additional 0.3cm port was done in 4 cases. The mean follow-up time was 22.36 ± 4.56months. Single-port laparoscopic percutaneous extraperitoneal closure of paediatric inguinal hernia using a needle grasper is a feasible and safe procedure. It has the advantages of fewer skin surgical incisions, short operating time, low complication and low recurrence rate.

Efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal bupivacaine in pediatric laparoscopic surgery: a randomized clinical trial

BackgroundWe evaluated the efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal (IP) bupivacaine in pediatric laparoscopic inguinal herniorrhaphy. MethodsNinety-seven male children, ASA I–II, 1–6 years old, undergoing laparoscopic inguinal herniorrhaphy, were randomized to receive before peritoneal insufflation, IP 2 mg.kg−1 bupivacaine 0.5% combined with either 1 μg.kg−1 of dexmedetomidine (Group D), 30 mg.kg−1 of magnesium sulfate (Group M), or normal saline (Group C). All tested drugs were diluted to the volume of 10 mL with normal saline. FLACC pain scores, need for rescue analgesics, time to flatus and first stool, emetic events, adverse effects, functional recovery, and parents’ satisfaction were recorded for the first 48 h postoperatively. ResultsFLACC scores were significantly higher in Group C than in the other two groups at 6, 8, 12, 18, 24, and 48 hours after surgery with no differences between Groups D and M. Rescue analgesia was significantly higher in Group C with none of the children in Groups D and M requiring rescue analgesia (p = 0.001). Times to first flatus and stool, emetic events, and adverse effects did not differ among groups. Times to return to normal functional activity were comparable in all groups. Parents’ satisfaction was greater in Groups D and M than in Group C (p = 0.026). ConclusionDexmedetomidine and magnesium sulfate added to IP bupivacaine improved the analgesia afforded by bupivacaine in the first two postoperative days in children scheduled for laparoscopic herniorrhaphy.

Pediatric Inguinal Hernia Repair, Laparoscopic Versus Open Approach: A Systematic Review and Meta-Analysis of the Last 10-Year Evidence.

Aim: Since the first description of laparoscopic herniorrhaphy (LH), a lot of studies have compared outcomes between LH and open herniorrhaphy (OH) with inconsistent results. We designed this study to assess outcomes between both techniques now that pediatric surgeons have enough confidence with it. Methods: We performed a systematic review and meta-analysis of articles published in the last 10 years. Results: Twenty-seven articles reporting on 91,653 patients (26,920 LH and 64,733 OH) were included. No significant differences were found in overall operative time (OT) (P = .07). Subgroup analysis revealed significantly shorter OT for LH in unilateral (-8.87 minutes, P = .03) and bilateral hernias (-16.86 minutes, P = .004), but longer in unilateral hernias in females (+7.47 minutes, P = .006). Recurrence rate was similar (odds ratio [OR] 1.05, P = .66). Less complications were reported in LH (OR 0.51, P = .03). Contralateral patent processus vaginalis average rate was 39.61% and its closure reported a significant decrease of contralateral metachronous hernia (OR 0.11, P < .00001). Conclusion: Although OH is still considered the gold standard by some authors, LH has proven to be not only as safe as OH but also to have additional advantages that should make pediatric surgeons implement it in their daily practice and not in selected cases alone.

Tele-consent using mixed reality glasses (NREAL) in pediatric inguinal herniorrhaphy: a preliminary study

There is an increasing demand and need for patients and caregivers to actively participate in the treatment process. However, when there are unexpected findings during pediatrics surgery, access restrictions in the operating room may lead to a lack of understanding of the medical condition, as the caregivers are forced to indirectly hear about it. To overcome this, we designed a tele-consent system that operates through a specially constructed mixed reality (MR) environment during surgery. We enrolled 11 patients with unilateral inguinal hernia and their caregivers among the patients undergoing laparoscopic inguinal herniorrhaphy between January through February 2021. The caregivers were informed of the intraoperative findings in real-time through MR glasses outside the operating room. After surgery, we conducted questionnaire surveys to evaluate the satisfaction and usefulness of tele-consent. We identified contralateral patent processus vaginalis in seven out of 11 patients, and then additionally performed surgery on the contralateral side with tele-consent from their caregivers. Most caregivers and surgeons answered positively about the satisfaction and usefulness of tele-consent. This study found that tele-consent with caregivers using MR glasses not only increased the satisfaction of caregivers and surgeons, but also helped to accommodate real-time findings by adapting surgical plan through the tele-consent.

Лапароскопічне лікування пахових гриж у дітей

Вступ. Операції з приводу пахових гриж є найбільш частими хірургічними втручаннями в дитячій хірургії, частота яких більше ніж 30 % від усіх планових операцій у дітей. Незважаючи на поширеність захворювання в дитячій популяції, кількість порівняльних досліджень відкритого та лапароскопічного підходів до лікування пахової грижі в дітей обмежена. Метою нашої роботи було оцінити результати лапароскопічних хірургічних втручань при пахових грижах у дітей.Матеріали та методи. Під нашим спостереженням перебували 458 дітей із паховими грижами в період 2011–2015 рр. Усі діти були прооперовані в плановому порядку. У 120 з усіх дітей використовували модифіковану методику, що полягала в проведенні гидравлічної препаровки парієтальної очеревини в ділянці внутрішнього кільця пахового каналу за допомогою попереднього введення в очеревину 0,25% розчину новокаїну. З метою об’єктивної оцінки кровотоку яєчка в післяопераційному періоді в дітей із паховою грижею проводили ультразвукову діагностику з допплерівським картуванням.Результати та обговорення. При аналізі отриманих даних виявлено, що однопортових операцій було виконано 369 (80 %). У 89 дітей проведено мультипортові операції. Дослідження кровотоку в яєчках у дітей першої групи вірогідно показали, що у 26,6 % із них було зниження кровотоку в яєчку з боку прооперованої грижі. У пацієнтів другої групи в післяопераційному періоді не виявлено значущих відхилень від норми. При спостереженні протягом 1 року після операції кількість пізніх післяопераційних ускладнень у пацієнтів була невеликою. Тільки у 12 (2,6 %) дітей першої групи відзначений рецидив грижі, в 11 (2,4 %) — водянка яєчка.Висновки. 1. Переважна більшість оперованих дітей була віком до 2 років. 2. Метод лапароскопічної герніорафії з гідропрепаровкою супроводжується більш низькою частотою рецидивів. 3. Така технологія є прийнятною для відтворення в умовах будь-якого дитячого хірургічного або урологічного відділення і може вважатися методом вибору при лікуванні дітей із паховою грижею.

A Rare Case of Prostatic Utricle with Crossover Vas Deferens in Children

Background: A prostatic utricle (PU) is an unusual pathology with most patients being asymptomatic. However, approximately 29% of patients may show lower urinary tract symptoms, recurrent urinary tract infections (UTI), postvoid dribbling, urethral discharge, epididymo-orchitis, stones, and secondary incontinence caused by urine trapping in the pouch and urinary retention. The standard treatment is through surgical resection, but it is only offered to patients with symptoms. Case summary: We report a case involving a six-year-old boy with congenital hypothyroidism and penoscrotal hypospadias who had previously undergone onlay urethroplasty for the proximal shaft, chordee release, orchidopexy for bilateral undescended testis, and laparoscopic herniorrhaphy for left inguinal hernia. However, the patient later evolved the repetition of UTI and right epididymo-orchitis. Cyclic voiding cystourethrography confirmed the presence of a cystic lesion communicating with the prostatic urethra from the utricle. The PU was then excised laparoscopically. The utricle was identified posterior to the bladder, and insertions of the vas deferens crossover into the utricle were detected by laparoscopy. The post-procedure course was uneventful. Conclusions: Laparoscopic resection of PUs offers a better exposure field, improved wound appearance, complete resection, and reduces the incidence of complications. During laparoscopy, the PU was clearly distinguished from the bladder or other pelvic organs. An incidental finding of vas deferens crossover has rarely been reported. A combined cystoscopy and laparoscopy for PU resection is executable, safe, and valid in this patient population.

Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery

BackgroundTo investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy.MethodsSeventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ngml-1), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points.ResultsA total of 52 child patients were used among the anticipated 75 patients. In groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences.ConclusionRemifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations.Trial registrationThe trial was registered at http://www.chictr.org.cn(ChiCTR1800019393, 8, Nov, 2018).