Laparoscopic High Ligation Research Articles

Anesthetic Management of Laparoscopic Surgery on a Pediatric Patient: Case Report

Inguinal hernia is an opening on myofascial oblique muscle and transversal muscle or the failure of Nuck canal or processus vaginalis during the gestation week which allows herniation of intra-abdominal or extraperitoneal organ. A 5-year-old child was diagnosed with a left lateral inguinal hernia. The results of the inguinal ultrasound showed movement and movement of the intestines in the left inguinal area through a defect measuring approximately 2.96 centimeters. The patient was planned to undergo laparoscopic high ligation hernia. Laparoscopic technique in adult commonly applied with special consideration. However, the practice in pediatric patient could be more challenging for anesthesiologist. Although laparoscopic surgery is less invasive it could cause more stress due to the pressure of the intra-abdominal pneumoperitoneum by CO2 that is done during the procedure, which then causes hypercapnea due to the absorption of CO2, the decrease of tidal volume, and the decrease of end-tidal volume. Considering pediatric’s different physiology compared to adult and the risks of laparoscopic surgery, special anesthesia management should be conducted.

Umbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of giant inguinal hernias in infants and young children

ObjectiveExploration of the efficacy of treating large indirect inguinal hernias in infants and young children using umbilical double-port laparoscopy combined with extraperitoneal water injection.MethodsA retrospective analysis was conducted on 165 cases of primary unilateral large indirect inguinal hernias in infants and young children treated at our hospital from May 2018 to May 2023. Among them, 90 cases underwent umbilical double-port laparoscopic surgery combined with extraperitoneal water injection and high ligation of the hernia sac (Double-Port Group), and another 75 cases underwent conventional three-port laparoscopic high ligation of the hernia sac (Three-Port Group). The two groups were compared in terms of operation time, postoperative pain scores at 24 hours, hospital stay, incision complications, and recurrence within one year after surgery.ResultsBoth groups successfully completed the surgery without any intraoperative complications. The pain score at 24 hours postoperatively was lower in the Double-Port Group compared to the Three-Port Group, and there was no statistically significant difference in operation time, hospital stay, and incision complications between the two groups (P > 0.05). Both groups were followed up for one year postoperatively; the Three-Port Group had one recurrence that was cured after further treatment, while there were no recurrences in the Double-Port Group.ConclusionUmbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of large indirect inguinal hernias in infants and young children has the advantages of being safe and reliable, with concealed and aesthetic incisions, and rapid recovery.

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia.

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

Effect of Alleviating Preoperative Anxiety on Gastrointestinal Function Recovery After Laparoscopic High Ligation of the Hernia Sac in Children with Indirect Inguinal Hernia.

Anxiety and depression can affect the physiology of the gastrointestinal tract through the brain-gut axis, causing gastrointestinal dysfunction, which is mainly manifested as indigestion, diarrhoea, constipation, or abdominal pain. Preoperative anxiety arises in children due to separation from parents, fear of unfamiliar surroundings and anaesthesia and surgical procedures.To discuss the effect of alleviating preoperative anxiety on postoperative recovery of gastrointestinal function in children with indirect inguinal hernia after laparoscopic high ligation of the hernia sac. 90 children with laparoscopic high ligation of the herniated sac in oblique inguinal hernia were randomly divided into control group (Group C) and experimental group (Group M). The Group M was given midazolam oral solution 0.5mg/kg (maximum dose 20mg), and The Group C was given 5% glucose solution with the same dose.Primary outcome was the time to first postoperative defecation and I-FEED scores.The secondary outcomes included mYPAS-SF scores; child sedation scores; child-parent separation scores; parental STAI scores;PHBQ scores;FLACC scores, operative time, and fluid input and surgeon job satisfaction. Compared with Group C, there was a shorter time to first postoperative defecation (P < 0.05), and lower I-FEED scores on postoperative day 1 (P < 0.05). The mYPAS-SF scores, which were significantly different in Group M at T1, T2, and T3 (P < 0.05), parental STAI scores at S1, child sedation scores and child-parent separation scores in T1, and surgeon job satisfaction between the two groups were significantly different (P < 0.05). There were no statistically significant differences in I-FEED scores on days 2 and 3, PHBQ scores, FLACC scores, operative time, and fluid input between the two groups of children (P > 0.05). Preoperative application of midazolam oral solution to relieve preoperative anxiety helps to promote the recovery of postoperative gastrointestinal function in children with indirect inguinal hernia and increases the surgeon job satisfaction.

A novel technique for the single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) of paediatric isolated giant inguinal hernias using double-modified hernia needles

The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children’s Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.

Evaluation of the Application Effect of Rapid Rehabilitation Surgery Concept in Nursing

Objective: To analyze the clinical value of perioperative nursing for children with laparoscopic high ligation of hernia sac under the guidance of the concept of rapid rehabilitation surgery. Methods: A total of 74 children with laparoscopic high ligation of hernia sac were selected from March 2021 to March 2022 in our hospital. Random number table method was used to divide them into an average group of 37 children. the control group was given routine perioperative care, and the observation group was given rapid rehabilitation surgery perioperative care. the postoperative recovery, complication rate and nursing satisfaction of parents were compared between the two groups. Results: the time of wake up, exhaust time, out of bed activity time and hospital stay in the observation group were shorter than those in the control group (P &lt; 0.05). the incidence of postoperative pain was 32.42% in the observation group and 59.46% in the control group, P &lt; 0.05; Postoperative complications were 5.41% in the observation group and 18.92% in the control group, P &lt; 0.05; Parents' nursing satisfaction in the observation group and the control group was 100.00% and 89.19% respectively, P &lt; 0.05. Conclusion: Perioperative nursing of rapid rehabilitation surgery for children with laparoscopic high ligation of hernia sac can promote postoperative rehabilitation, reduce complication rate and harmonize nurse-patient relationship.

A rare case of perineal neuralgia treated with ultrasound‐guided nerve block combined with water separation

AbstractA middle‐aged man experienced intermittent acupuncture‐like pain in the skin of the right scrotum and medial thigh 1 month after undergoing laparoscopic high ligation of the right hernial sac for a right indirect inguinal hernia in November 2020, and the pain persisted for 6 months. Under ultrasound guidance, ilioinguinal and genitofemoral nerve block and local adhesion water separation were performed with a mixture of 0.25% lidocaine (6 mL) plus prednisolone acetate (10 mg), and the same drugs and methods were repeated five times once a week. After five treatments, the visual analogue scale (VAS) score was reduced from 7 before treatment to 1. During the follow‐up period, at 3 months after the end of treatment, the VAS score remained at 0, and this score was sustained at 0 even at the 6‐month follow‐up. These outcomes indicate that ultrasound‐guided nerve block combined with water separation technology can effectively alleviate neuralgia caused by surgical adhesion, which holds important clinical significance in managing such conditions.

Analysis of the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia

ObjectiveInguinal hernias are a common disease that may present at all ages. Adolescents are a unique patient population between children and adults. The etiology and the surgical treatment strategies of adolescent indirect hernias are not clear. Specifically, whether these kinds of hernias should be treated by high ligation or mesh repair remains controversial. We aimed to evaluate the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia.MethodsThe data of adolescent patients who underwent laparoscopic high hernia sac ligation at the The First People’s Hospital of Foshan,China, from January 2012 to December 2019 were analyzed retrospectively. Data collected included their age, gender, weight, surgical method, hernia ring diameter, operation time, postoperative recurrence rate and postoperative complications.ResultsA total of 70 patients were enrolled, including 61 males (87.14%) and 9 females (12.86%),all patients were aged 13–18 years old (mean 14.87 ± 1.56years), weighed 28-92 kg (mean 53.04 ± 10.60 kg). All 70 patients underwent laparoscopic surgery except 2 patients with irreducible hernias who converted to laparotomy.The hernia ring diameter ranged from 0.5 to 3 cm (mean 1.39 ± 0.49 cm), and was ≤ 2 cm in 68 cases (97.14%).The operative length ranged from 12 to 105 min (average 24.96 ± 12.61 min), There were 37(52.9%) right-sided hernias, 32 (45.7%) left-sided hernias, 1 (1.4%) bilateral hernia.There were 67(95.7%)reducible hernias,2(2.9%)irreducible hernias ,and 1(1.4%)incarcerated hernia.Hospital stays ranged from 1 to 5 days (mean 2.37 ± 1.05 days). Follow-ups were performed from 30-119months (mean 74.27 ± 28.14months). There were no cases of recurrence, howere, incision infection occured in 1 patient, who underwent a second operation 6 months after surgery, and 4 (5.7%) patients had complaints of intermittent pain around the ligation incision site, mostly during exercise .ConclusionLaparoscopic high hernia sac ligation is feasible for treatment of adolescent indirect hernias with a hernia ring diameter of ≤ 2 cm.

Analysis of Contralateral Patent Processus Vaginalis in Laparoscopic High Ligation of the Vaginal Process and Clinical Long-term Effect of Individualized Treatment

Background: We aimed to analyze contralateral patent processus vaginalis (CPPV) in the laparoscopic high ligation of the vaginal process, treat eligible children surgically, and evaluate the clinical long-term outcomes. Methods: A total of 300 children with unilateral inguinal hernia or unilateral hydrocele treated in our hospital were selected for laparoscopic high ligation of the vaginal process, during which CPPV was analyzed. The 300 children were randomly divided into two groups of 150. In the study group (n = 58), 11 children met the requirements of high ligation and were treated with simultaneous surgery. The 53 children in the control group received simultaneous treatment. The prevalence of CPPV was compared between children with unilateral indirect inguinal hernia and unilateral hydrocele, left and right patent processus vaginalis (PPV), and different ages. After surgery, both groups were followed up for one year. The recurrence rate of contralateral indirect inguinal hernia or hydrocele was compared. Significant differences were assessed between the two groups receiving different treatments. Results: The prevalence of CPPV was 23% in children with unilateral indirect inguinal hernia and 49% in children with unilateral hydrocele. The prevalence of CPPV in children with unilateral hydrocele was significantly higher than that in children with inguinal hernia (P = 0.00). The prevalence of CPPV was 42% in children with left PPV and 33% in children with right PPV, without a statistically significant difference (P = 0.19). The prevalence of CPPV was 63% in children aged 1 - 2 years, which was significantly higher than that in other age groups (χ2 = 7.46, P = 0.01). The prevalence of CPPV was 14% in children aged &gt; 6 years, which was significantly lower than that in other age groups (χ2 = 4.43, P = 0.04). A postoperative one-year follow-up showed that the recurrence rate was 9% in the study group and 1% in the control group, without a statistically significant difference (P = 0.25). Conclusions: The prevalence of CPPV decreases with age. Hydrocele combined with CPPV is more common. For younger children with hydrocele, it is very important to explore the contralateral side during surgery. Moreover, the transformation of CPPV to indirect inguinal hernia or hydrocele occurs rarely, and only eligible children can receive simultaneous treatment during surgery.

Application of Noncontact Laparoscopic High Ligation of the Hernia Sac of the Vas Deferens in Children with Indirect Inguinal Hernia.

Objective: This study aims to evaluate the usefulness of vas deferens noncontact laparoscopic high ligation of the hernia sac in children with indirect inguinal hernia (IIH). Materials and Methods: The clinical data of 146 male children with IIH treated in the Anhui Children's Hospital from January 2018 to June 2019 were analyzed retrospectively. There were 82 patients in the observation group in which the inner ring opening was sutured and closed using the vas deferens noncontact suture and 64 patients in the control group in which the peritoneum at the inner ring opening was closed using the intradermal suture. The operation time, surgical complications, postoperative complications, and recurrence rate were compared between the two groups (followed up for 2 years). Results: The operation was successful in all the patients in both groups. In the observation group, there was one case of intraoperative spermatic cord vascular injury and one case of infra-abdominal wall vascular injury, and no intraoperative complications occurred in the control group. The operation time was 12.8 ± 1.4 minutes in the control group and 10.4 ± 2.6 minutes in the observation group (P < .01). The two groups of patients were followed up for 2 years, and no complications and no recurrence occurred. Conclusion: The vas deferens noncontact laparoscopic high ligation of the hernia sac to close the inner ring opening has several advantages: The operation is simple; the operation time is shorter than the traditional method, avoiding the possibility of vas deferens injury; and it is a safe, reliable, and effective surgical method. However, due to the small number of clinical cases in this study, its long-term effect requires further observation.

Clinical effects of laparoscopic treatment of unilateral inguinal indirect hernia in children with occult patent processus vaginalis and nano-silver antibacterial dressing in postoperative wound recovery

Currently, laparoscopic high ligation of the hernia sac (LHLOHS) is the first choice for treating inguinal indirect hernia in children (IIHIC) with intraoperative occult patent processus vaginalis. However, postoperative incision infection and delayed healing significantly affect surgical efficacy and recovery prognosis. In this study, 214 children with indirect inguinal hernia were analyzed and assigned to two groups according to the surgical methods used; a traditional group (n = 68) and a laparoscopic group (n = 136). The traditional group underwent traditional high ligation of the hernia sac, while the laparoscopic group underwent LHLOHS. After surgery, the laparoscopic group was randomly assigned to Vaseline dressing (VD) and nano-silver antibacterial dressing (NSAD) groups (n = 68, each). Compared with the traditional group, the laparoscopic group showed improved surgical indicators, shorter hospital stays, higher recovery rates, lower complication incidence and similar recurrence rates. Compared with the VD group, the wound healing and recovery rates of the NSAD group were higher while complication incidence was lower, wound healing time become shorter, and procalcitonin and C-reactive protein levels normal before and after the operation (P &lt;0.05). The results indicated that LHLOHS and NSAD had significantly positive effects on postoperative wound recovery and a high clinical application value.

Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants

BackgroundThe purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children.MethodsThe clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.ResultsAll procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma.ConclusionsSingle-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children.

In order to solve the stress problem in laparoscopic hiatal hernia repair of children, improve surgical safety, and reduce surgical risk, this study compared the perioperative changes of epinephrine, norepinephrine, IL-6, IL-10, and hemodynamics in children undergoing laparoscopic surgery under intravenous general anesthesia and general anesthesia combined with an epidural block. In this study, 40 children aged 1–3 years who planned to undergo laparoscopic ortopexy and those who planned to undergo laparoscopic high ligation of hernia sac, aged 23.84 1.6 months and weighed 14.9 1.1 kg, were randomly divided into general anesthesia combined with the epidural block group (group A) and a total intravenous anesthesia group (group B), with 20 subjects in each group. The results are as follows: There were no differences in age, gender, body weight, anesthesia time, pneumoperitoneum duration, and functional time between the two groups. Cytokines: Compared with T0, the levels of IL-6 in T2, T3, T4, and T5 groups were significantly increased (P < 0.01). IL-10 levels: T2, T3, T4, and T5 groups were further increased, and the difference was statistically significant compared with T0 (P < 0.01). There was no difference between groups (P > 0.05). The recovery time in group B was shorter than that in group A (P < 0.01), and the total amount of propofol and fentanyl in group B was less than that in group A (P < 0.01). Through research on intravenous anesthesia treatment, it has been proved that total intravenous anesthesia can relieve perioperative pressure, reduce intravenous injection, and reduce the recovery time of children. However, its effect on cytokines is not obvious, so intravenous anesthesia is the most appropriate anesthesia mode in laparoscopic hiatal hernia repair surgery, which has practical significance.

How to choose a suitable intraabdominal pressure level during single-incision laparoscopic surgery in children

Laparoscopic surgery has become a common procedure in pediatric patients. However, adverse hemodynamic changes such as the increase of intraabdominal pressure (IAP) may occur laparoscopic surgery. The aim of this study is find a method to set a suitable IAP level in children before laparoscopic surgery. From Jan 2012 to Dec 2014, data were collected from a total of 1776 children needing laparoscopic high ligation of hernia sac. A retrospective data analysis was performed using a new defined variant Index A which had information of age, body mass index (BMI) and duration of pneumoperitoneum. The blood pressures (SBP and DBP) and the PaCO2 were increased but SV showed no changes in patients after CO2 insufflation. The complications were found in 32 cases including 2 cases with subcutaneous emphysemarelated to the CO2 insufflation directly, 3 cases of respiratory infection, 5 cases of incision infection and 2 cases of urinary tract infection) and technique related. Furthermore, the risks of complications were negatively associated with the Index A. An IAP can be optimal set up in laparoscopic high ligation of hernia sac by using the Index A.

Multifactor study of efficacy and recurrence in laparoscopic surgery for inguinal hernia.

BACKGROUNDInguinal hernia is a common clinical manifestation in children with a low self-healing rate. AIMTo determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperative recurrence and to provide a reference for the clinical treatment and prevention of recurrence.METHODSWe selected 360 children who underwent laparoscopic high ligation in our hospital as the laparoscopic group and 120 patients treated for inguinal hernia with conventional surgery as the control group. The operation time, blood loss, incision length, hospitalization time, total hospitalization cost and surgical complications were compared between the two groups. According to telephone follow-up or return visits, the children who had recurrence within 2 years after the operation in the laparoscopic group were analyzed, and the laparoscopic high ligation hernia sac level was analyzed by the logistic multifactor method. Ligation was used to treat recurrence in children with inguinal hernia.RESULTSThe operation time, blood loss, length of incision, and length of hospital stay in the laparoscopic group were lower than those in the control group (P < 0.05). The total hospitalization cost in the laparoscopic group was higher than that in the control group (P < 0.05). The operative complication rate was 1.67% lower than that in the control group (12.50%) (P < 0.05). In 360 children with laparoscopic high ligation of the hernia sac, 14 patients had recurrence within 2 years after surgery. After analysis, 14 cases in the recurrence group did not recur. The preoperative incarceration rate, inner ring diameter, ligature use and age difference were statistically significant (P < 0.05). According to logistic regression multivariate analysis, an inner ring diameter ≥ 1.0 cm, the use of an absorbable ligature line and age > 3 years increased the risk of postoperative recurrence in children with inguinal hernia after laparoscopic high ligation of the hernia sac (P < 0.05). CONCLUSIONLaparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery. An inner ring diameter ≥ 1.0 cm, the use of absorbable ligature, and age > 3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac.

Recurrence after laparoscopic high ligation in adolescents: A multicenter international retrospective study of ten hospitals

PurposeInguinal hernia repairs are among the most common operations performed by pediatric surgeons. Laparoscopic high ligation is a popular technique, but its recurrence rate in adolescents is unknown. We hypothesized that recurrence after laparoscopic high ligation in adolescents would be similar to open repair (1.8%–6.3%). MethodsWe evaluated adolescent patients (12–18 years old at the time of surgery) who underwent laparoscopic high ligation across eleven hospitals. At least six months postoperatively, they were contacted by telephone for follow-up. Variables analyzed included demographics, operative details, recurrence, and other complications. ResultsA total of 144 patients were enrolled. One hospital (n=9) had a recurrence rate of 44.4%, compared to 3.0% (4/135) for the other hospitals. By accounting for 50.0% of recurrences, it represented a statistical outlier and was excluded, leaving 135 patients for analysis. The median age was 14 years, and 63.7% were male. Recurrence with the excluded center was 5.6% (8/144). Use of absorbable suture (OR 42.67, CI 4.41–412.90, p<0.01) and braided suture (OR 12.10, CI 1.54–95.25, p=0.02) was weakly associated with recurrence. Recurrence was not significantly different from published results. ConclusionLaparoscopic high ligation of adolescent inguinal hernias has a recurrence rate similar to open repair when performed by experienced surgeons. Type of studyPrognosis study (retrospective study) Level of evidenceLevel II

Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle: a novel technique for pediatric inguinal hernia.

Laparoscopic high ligation of the internal inguinal ring is an alternative procedure for treatment of pediatric inguinal hernia (PIH), with a major trend toward increasing use of extracorporeal knotting and decreasing use of working ports. We have utilized this laparoscopic technique to treat the entire spectrum of PIH (including incarcerated cases) for more than 17years, and the technique continues to evolve and improve. We herein report our latest modification of this minimally invasive technique, namely single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac high ligation using an ordinary taper needle, and evaluate its safety and efficacy. From July 2016 to July 2019, 790 children with indirect PIH were treated by laparoscopic surgery. All patients underwent high ligation surgery with a modified single-site laparoscopic technique mainly performed by extracorporeal suturing with an ordinary closed-eye taper needle (1/2 arc 11 × 34). The clinical data were retrospectively analyzed. All surgeries were successful without serious complications. A contralateral patent processus vaginalis (CPPV) was found intraoperatively and subsequently repaired in 190 patients (25.4%). The mean operative time was 15min (8-25min) for 557 unilateral hernias and 21min (14-36min) for 233 bilateral hernias. The mean postoperative stay was 20h. Minor complications occurred in five patients (0.63%) and were managed properly, with no major impact on the final outcomes. No recurrence was noted in the patients who were followed up for 6-42months. No obvious scar was present postoperatively. Modified SLPEC of hernia sac high ligation using an ordinary taper needle for repair of indirect PIH is a safe, reliable, and minimally invasive procedure with satisfactory outcome, with no special device being needed. It is easy to learn and perform and is worthy of popularization in the clinical setting.

Development and current status of treatment for pediatric indirect inguinal hernia

To investigate the development and current status of the treatment of pediatric indirect inguinal hernia. Inguinal hernias include indirect hernias and direct inguinal hernias, but there are almost indirect inguinal hernias in children . Pediatric indirect inguinal hernia that the most common disease in pediatric surgery is almost caused by patent processus vaginali which incidence ranges from 0.8% to 4.4%.The treatment of pediatric indirect inguinal hernia reflects the process of pediatric surgery development, which from conservative non-surgical treatment to high ligation of the longitudinal incision hernia sac. In recent years, with the continuous improvement of medical level in China, laparoscopic technique has been applied in hospitals all over China, and laparoscopic high ligation of indirect inguinal hernia sac has become the standard for the treatment of pediatric indirect inguinal hernia.

47: Pelvic congestion syndrome: A laparoscopic approach

The goal of this video is to demonstrate a laparoscopic approach for the management of chronic pelvic pain secondary to pelvic congestion syndrome presented by large tortuous ovarian vessels. Pelvic congestion syndrome is found in 30% of patients complaining of chronic pelvic pain and in who work up reveals no pathologies. Although the etiology of pelvic congestion syndrome is still not clear, multiple treatment modalities are available for the symptomatic patient. Our patient is a 69-year-old patient with one-year history of left lower quadrant pelvic pain. CT abdomen/ pelvis showed congested pelvic vessels on the left side and a small persistent ovarian cyst. Decision was made to perform laparoscopic ligation of the left ovarian veins with concurrent bilateral salpingo-oophorectomy. Laparoscopic high ligation of the ovarian vessels is described. After adequate exposure of the infundibulopelvic ligament and identification of the surrounding structures, the ovarian vein was isolated, sealed, and transected above the pelvic brim. Careful systematic dissection of the pelvic sidewall ensures uncomplicated resection of the congested ovarian venous plexus. Our video demonstrates a minimally invasive approach to pelvic congestion syndrome. The laparoscopic high ligation technique is often chosen when a concurrent gynecologic surgery is required.

Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants

Objective To investigate the risk factors for appendicitis caused by incarcerated inguinal hernia in infants. Methods The retrospective case-control study was conducted. The clinicopathological data of 371 infants with incarcerated inguinal hernia who were admitted to Wuhan Children′s Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2010 and December 2018 were collected. There were 256 males and 115 females, aged from 0 to 90 days, with an average age of 47 days. Observation indicators: (1) situations of incarcerated hernia; (2) surgical and postoperative recovery; (3) postoperative pathological examination; (4) analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants. Measurement data with skewed distribution were described as M (range). Count data were expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was performed using the Logistic regression model. Results (1) Situations of incarcerated hernia: of the 371 infants, 264 had bowel incarceration, 102 had ovarian incarceration, 2 had both bilateral ovarian and bowel incarceration, 1 had bilateral ovarian and womb incarcerated into one side, and 2 had Meckel′s diverticulums incarceration. Among the 264 infants with bowel incarceration, 29 had Amyand′s hernia, including 18 of ileocecal incarceration (3 with appendicitis) and 11 of pure appendix incarceration (10 with appendicitis). (2) Surgical and postoperative recovery: of the 29 infants with Amyand′s hernia, 10 underwent laparoscopic hernia sac high ligation and 19 underwent inguinal explorations, relaxation of hernia ring and then hernia sac high ligation. One infant undergoing laparoscopic hernia sac high ligation had pure appendix incarceration. It showed that chorda at the blind end of appendix was connected with the bottom of hernia sac intraoperatively. There was no obvious inflammation in the appendix. Chorda was released, and the appendix was reset into the abdominal cavity. One infant was resected appendix because of its inflammation after ileocecal reduction. Twelve infants undergoing inguinal explorations, relaxation of hernia ring and then hernia sac high ligation had appendicitis (2 of ileocecal incarceration and 10 of pure appendix incarceration), and received appendectomy and hernia sac high ligation. One infant of ileocecal incarceration had postoperative intestinal adhesion, and was found local adhesion and stenosis after abdominal re-exploration. The infant underwent ileocecoectomy followed by ileum-ascending colon anastomosis. All infants recovered well after operation. (3) Postoperative pathological examination: 13 of 29 Amyand′s hernia infants had appendictis, 4 of which were confirmed as appendix suppuration by pathological examination, 2 were appendix suppuration and perforation, and 2 were gangrene. (4) Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia. Results of univariate analysis showed that age, local swelling and erythema of the hemiscrotum, intestinal obstruction, and incarceration location were related factors for the appendicitis caused by incarcerated inguinal hernia (χ2=10.598, 15.603, 9.732, 3.866, P<0.05). Multivariate analysis showed that age less than 28 days, local swelling and erythema of the hemiscrotum, no obvious obstruction were the independant risk factors for appendicitis caused by incarcerated inguinal hernia (odds ratio: 4.537, 35.506, 34.565, 95% confidence interval: 1.014-20.296, 6.447-195.552, 6.370-187.546, P<0.05). Conclusion Age less than 28 days, local swelling and erythema of the hemiscrotum, and no obvious obstruction are independent risk factors for appendicitis caused by incarcerated inguinal hernia. Key words: Hernia; Incarcerated inguinal hernia; Amyand′s hernia; Appendicitis; Neonate; Risk factors